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Patient Safety and Health Information Technology: Role of the Electronic Health Record.


In: Hughes RG, editor.


Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 47.
Advances in Patient Safety.

Author information

Nancy Staggers, Ph.D., R.N., F.A.A.N., Associate Professor of Informatics, University of Utah College of Nursing, adjunct Associate Professor, School of Medicine. E-mail:
Charlene Weir, Ph.D., R.N., Associate Director of Education and Evaluation, VA GRECC, Salt Lake City, UT. E-mail:
Shobha Phansalkar, R.Ph., Ph.D., Informatician, Partners Healthcare System, Inc., Instructor, Harvard Medical School. E-mail: (This chapter was written while she was a doctoral candidate at the University of Utah Department of Biomedical Informatics.)


Across the sections in this chapter, several themes are apparent. First, nursing and nursing impacts are nearly absent in the current empirical studies of work on EHR orders and clinical decision support within ordering systems. Future research is needed to understand the impact of that technology on the role of nurses and workflow methods that are effective for nurses in a computerized orders environment. Nursing clearly participates in the orders process; yet, the assessment of that role is missing to date. More important, nurses and pharmacists serve in roles as protectors against errors in patient care. The counts of intercepted errors speak to this role in a simplistic way. More complex variables and expanded research is needed on this topic. With CDSS, nurses are studied as invisible partners in the care process rather than as decisionmakers themselves. Yet, nurses make thousands of care decisions a day. Borrowing methods from psychology, future researchers could expand the cognitive work in this area. BCMA is the exception to the absent nursing voice. In BCMA, nurses are integral to the success of the application. Medication error reduction with BCMA is apparent. Additionally, the VHA has effectively included nurses in the design and implementation of technology-assisted medication administration. However, technology assistance in medication administration represents a lower-level cognitive process than, say, decisionmaking about symptom assessment or an independent care intervention. Thus, future research on decision support for higher cognitive processes and the nurse as a full-fledged decisionmaker is warranted. There are several limitations to this work. A strong effort was made to have well-defined inclusion criteria to make the studies as homogeneous as possible and to allow valid comparisons. However, the inclusion criteria have limited this analysis to implemented solutions, narrowing the possible CDSS applications in particular. Likewise, studies were excluded from areas such as imaging and psychiatry; in the future these areas could be examined. Our results included some qualitative work, not usually considered as evidence, but included here to better describe the phenomena at hand. An analysis without qualitative studies would perhaps come to different conclusions. Studies in sociotechnical and human-computer interaction are needed in each of these areas. This would help us understand the complex processes inherent in technology design and adoption. Interdisciplinary examinations are needed in future research to understand interdependent roles. With technology becoming an omnipresent participant on today’s health care teams, traditional roles on a health care team have been altered. For example, computerized orders management changes roles, and role renegotiation must take place. New process and new issues emerge with complex technologies like CPOE; this interdependence needs to be systematically evaluated in the future. The research in HIT integrative functions is just beginning. Future opportunities are many for areas of great impact to nursing.

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