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J Am Med Inform Assoc. 2018 Jul 1;25(7):848-854. doi: 10.1093/jamia/ocy034.

Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system.

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Massachusetts General Hospital, Boston, MA, USA.



While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic.


Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme.


After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards.


Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.


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