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Collecting real-time audio, video, and system data enables identification of process vulnerabilities. This commentary discusses the current state of black box approaches to collect surgical procedure data in situ and highlights challenges to its effective use and implementation to improve surgical safety.

Electronic health records (EHRs) hold great promise for improving patient safety, but remain underutilized, especially in ambulatory care settings. Failure to appropriately follow up on abnormal test results is a common ambulatory care safety problem, and has been implicated in malpractice lawsuits arising from missed or delayed diagnoses. In this study conducted at eight family medicine clinics, those with an EHR documented clinician and patient notification of abnormal test results and clear follow-up plans more often than those with paper charts. However, even in clinics using EHRs, more than one-third of abnormal results had no follow-up plan documented. This finding corroborates prior research that clinician notification alone does not ensure timely and complete follow-up of test results.

This study used a log file within a computerized physician order entry (CPOE) system to understand the role physician- and policy-related variables, as well as patient resistance, played in responding to electronic reminders about drug duplication orders.