IOM's 1999 landmark study To Err is Human estimated that between 44,000 and 98,000 lives are lost every year due to medical errors. This call to action has led to a number of efforts to reduce errors and provide safe and effective health care. Information technology (IT) has been identified as a way to enhance the safety and effectiveness of care. In an effort to catalyze its implementation, the U.S. government has invested billions of dollars toward the development and meaningful use of effective health IT.

Designed and properly applied, health IT can be a positive transformative force for delivering safe health care, particularly with computerized prescribing and medication safety. However, if it is designed and applied inappropriately, health IT can add an additional layer of complexity to the already complex delivery of health care. Poorly designed IT can introduce risks that may lead to unsafe conditions, serious injury, or even death. Poor human-computer interactions could result in wrong dosing decisions and wrong diagnoses. Safe implementation of health IT is a complex, dynamic process that requires a shared responsibility between vendors and health care organizations. Health IT and Patient Safety makes recommendations for developing a framework for patient safety and health IT. This book focuses on finding ways to mitigate the risks of health IT-assisted care and identifies areas of concern so that the nation is in a better position to realize the potential benefits of health IT.

Health IT and Patient Safety is both comprehensive and specific in terms of recommended options and opportunities for public and private interventions that may improve the safety of care that incorporates the use of health IT. This book will be of interest to the health IT industry, the federal government, healthcare providers and other users of health IT, and patient advocacy groups.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON PATIENT SAFETY AND HEALTH INFORMATION TECHNOLOGY
• Reviewers
• Preface
• Acknowledgments
• Abbreviations and Acronyms
• Summary
  • EVALUATING THE CURRENT STATE OF PATIENT SAFETY AND HEALTH IT
  • EXAMINING THE CURRENT STATE OF THE ART IN SYSTEM SAFETY
  • OPPORTUNITIES TO BUILD SAFER SYSTEMS FOR HEALTH IT
  • PATIENTS’ AND FAMILIES’ USE OF HEALTH IT: CONCERNS ABOUT SAFETY
  • A SHARED RESPONSIBILITY FOR IMPROVING HEALTH IT SAFETY
  • FUTURE RESEARCH FOR CARE TRANSFORMATION
• 1. Introduction
  • PATIENT SAFETY
  • HEALTH IT
  • INTERSECTION OF PATIENT SAFETY AND HEALTH IT
  • IOM COMMITTEE
  • RECOMMENDATIONS FROM PREVIOUS IOM REPORTS REGARDING HEALTH IT
  • REPORT STRUCTURE
  • REFERENCES
• 2. Evaluating the Current State of Patient Safety and Health IT
  • COMPLEXITY OF HEALTH IT AND PATIENT SAFETY
  • LIMITATIONS OF CURRENT LITERATURE TO DETERMINE HEALTH IT’S IMPACT ON PATIENT SAFETY
  • BARRIERS TO KNOWING THE MAGNITUDE OF THE HARM
  • IMPACT OF HEALTH IT COMPONENTS ON PATIENT SAFETY
  • LEVERAGING EHR DATA TO IMPROVE SAFETY OF POPULATIONS
  • LESSONS FROM THE INTERNATIONAL COMMUNITY: INTERNATIONAL COMPARISONS
  • CONCLUSION
  • REFERENCES
• 3. Examination of the Current State of the Art in System Safety and Its Relationship to the Safety of Health IT–assisted Care
  • SAFETY IN COMPLEX SYSTEMS
  • THE NOTION OF A SOCIOTECHNICAL SYSTEM
  • SAFETY AS A SYSTEM PROPERTY
  • THE NEED FOR AN EXPLICIT EVIDENCE-BASED CASE FOR SAFETY IN SOFTWARE
  • THE (MIS)MATCH BETWEEN THE ASSUMPTIONS OF SOFTWARE DESIGNERS AND THE ACTUAL WORK ENVIRONMENT
  • SAFETY REPORTING AND IMPROVEMENT
  • CONCLUSION
  • REFERENCES
• 4. Opportunities to Build a Safer System for Health IT
  • FEATURES OF SAFE HEALTH IT
  • OPPORTUNITIES TO IMPROVE THE DESIGN AND DEVELOPMENT OF TECHNOLOGIES
  • OPPORTUNITIES TO IMPROVE SAFETY IN THE USE OF HEALTH IT
  • MINIMIZING RISKS OF HEALTH IT TO PROMOTE SAFER CARE
  • CONCLUSION
  • REFERENCES
• 5. Patients’ and Families’ Use of Health IT: Concerns About Safety
  • PATIENT-CENTERED CARE AND THE ROLE OF HEALTH IT
  • GROWTH OF CONSUMER HEALTH IT
  • PERSONAL HEALTH RECORDS
  • MITIGATING SAFETY RISKS OF PATIENT ENGAGEMENT TOOLS: “RULES OF ENGAGEMENT”
  • POPULATION HEALTH MANAGEMENT
  • CONCLUSION
  • REFERENCES
• 6. A Shared Responsibility for Improving Health IT Safety
  • THE ROLE OF THE PRIVATE SECTOR: PROMOTING SHARED LEARNING ENVIRONMENTS
  • THE ROLE OF THE PUBLIC SECTOR: STRATEGIC GUIDANCE AND OVERSIGHT
  • NEXT STEPS
  • CONCLUSION
  • REFERENCES
• 7. Future Research for Care Transformation
  • DESIGN AND DEVELOPMENT OF TECHNOLOGIES
  • IMPLEMENTATION AND USE OF TECHNOLOGIES
  • CONSIDERATIONS FOR RESEARCHERS
  • POLICY ISSUES
  • SUPPORTING FUTURE RESEARCH
  • REFERENCES
• APPENDIXES
  • Appendix A Glossary
  • Appendix B Literature Review Methods
  • Appendix C Abstract of “Roadmap for Provision of Safer Healthcare Information Systems: Preventing e-Iatrogenesis”
  • Appendix D Abstract of “The Impact of Regulation on Innovation in the United States: A Cross-Industry Literature Review”
  • Appendix E Dissenting Statement: Health IT Is a Class III Medical Device
  • Appendix F Committee Member and Staff Biographies

This study was supported by Contract No. HHSP23337018T between the National Academy of Sciences and the United States Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2012. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.