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Donovan-Smith O. Spokesman-Review. September 11, 2022.

Electronic health record (EHR) system issues degrade the data sharing and communication needed to inform safe patient care. This newspaper feature discusses problems with the new Veterans Affairs EHR system from the patient and family perspective in the context of diagnostic and treatment delay.

Washington DC; United States Government Accountability Office; November 26, 2020. Publication GAO-21-7SP.

Artificial intelligence (AI) has the potential to enhance the safety and reliability of clinical and administrative functions. This US Government Accountability Office report outlines barriers impacting the widespread use of AI, such as privacy concerns and lack of development transparency. Collaboration and oversight are areas of policy focus highlighted to address these challenges.

Heaven WD. MIT Technology Review. November 12, 2020.

Lack of transparency of research and development processes are thought to undermine the value of artificial intelligence (AI) and trust in its conclusions. This story highlights concerns generated by AI research examining breast cancer screening. The author discusses how the lack of transparency, while understandable due to proprietary concerns, may reduce the safety of the tools as they are tested for use.
Blease CR, Bell SK. Diagnosis (Berl). 2019;6:213-221.
Despite growing support for patient involvement in safety and quality improvement, little is known about engaging patients as partners in reducing diagnostic error. This commentary summarizes research on how sharing notes with patients can improve the timeliness of follow-up to confirm a diagnosis, identify documentation errors, and strengthen communication between the clinical team and the patient. The authors discuss challenges to the successful implementation of this strategy and areas of focus needed for future development. A PSNet interview discussed use of OpenNotes to engage patients in their care.
Sentinel event alert. 2018:1-8.
Although adverse events and near misses are common in health care, they are almost ubiquitously underreported. Barriers to reporting include health care provider fear of repercussions, insufficient integration of reporting systems into the electronic health record, and cultural factors. This new sentinel event alert explores how organizations can change their culture to promote reporting. It highlights bright spots: organizations that use a just culture approach to investigating errors, celebrate employees who report safety hazards, and whose leaders prioritize reporting. The Joint Commission proposes actions for all organizations to take, including developing incident reporting systems, promoting leadership buy-in, engaging in systemwide communication, and implementing transparent accountability structures. An Annual Perspective reviewed the context of the no-blame movement and the recent shift toward a framework of a just culture.
Ratwani RM, Hodgkins M, Bates DW. JAMA. 2018;320:2533-2534.
Transparency in health care has been heralded as a cornerstone to improvement. This commentary spotlights how electronic health record vendors prevent health care organizations from sharing information about usability and safety issues, hindering efforts to research weaknesses and design improvements for electronic health records.
Porter S.
Overreliance on technology can result in harmful medication mistakes. Reporting on a 10-fold medication overdose that led to the death of a patient with dementia, this news article describes how the hospital changed their processes to improve medication safety, which included restructuring medication safety leadership, modifying the electronic health record to address alert overrides, and enhancing information sharing to support learning and transparency.
Boodman SG.
Although providing patients with access to physician notes and test results supports transparency and patient engagement, it can also introduce certain challenges. This newspaper article reports on unintended psychological stresses associated with direct patient access to test results without appropriate contextual information. Improvement strategies include use of graphics, timely patient-centered communication, and scheduling appointments to discuss results. A PSNet perspective explored how patient-facing technologies can empower patients and improve safety.
Resneck JS, Abrouk M, Steuer M, et al. JAMA Dermatol. 2016;152:768-75.
Telemedicine is being more widely used in order to increase access to care. A relatively new aspect of telemedicine is direct-to-consumer telemedicine, including teledermatology. Using secret shoppers who submitted photographs and clinical information to teledermatology sites, this study found poor diagnostic accuracy and failure to elicit important information. Other studies have also raised concerns about the diagnostic accuracy of virtual clinical visits.

Millenson ML. Chicago, IL: University of Chicago Press; 1999. ISBN: 9780226525884.

Millenson, a Pulitzer-nominated former health care writer, discusses the health care quality movement and the increasingly important role of information technology in both measuring and promoting quality. He covers a broad range of topics in a somewhat journalistic tone, from quality assessment to evidence-based medicine, from accountability to pay-for-performance. Although the book is nearly a decade old, it remains important for having laid out a vision for the use of information and computerization in assessing and promoting quality. Although the book includes sections on patient safety, its strengths are those on quality assessment and improvement.