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EHR Safety: The Way Forward to Safe and Effective Systems

^a Geisinger Health System, Danville, PA
^b EHR Safety Institute, Danville, PA
^c Department of Industrial and Systems Engineering, and Center for Quality and Productivity Improvement, University of Wisconsin, Madison, WI
^d Department of Aeronautics and Astronautics, and Department of Engineering Systems and Complex Systems Research Lab, Massachusetts Institute of Technology, Cambridge, MA
^e American College of Physicians, Philadelphia, PA
^f Clinical Information Systems, Kaiser Permanente Northwest Region, Portland, OR
^g Geisinger Center for Health Research, Danville, PA.

^_* Correspondence: James M. Walker, MD, FACP, Geisinger Health System, MC 30-06, 100 North Academy Avenue, Danville, PA 17822-3006 (Email: jmwalker{at}geisinger.edu).

Received for publication: 09/14/07; accepted for publication: 02/13/08.

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.