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First published February 28, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2618
Journal of the American Medical Informatics Association 2008;15(3):272-277
© 2008 American Medical Informatics Association

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Submitted on September 14, 2007
Accepted on February 13, 2008

EHR Safety: The Way Forward to Safe and Effective Systems

James M. Walker MD1*, Pascale Carayon PhD2, Nancy Levenson PhD3, Ronald A. Paulus MD, MBA4, John Tooker MD, MBA5, Homer Chin MD6, Albert Bothe Jr. MD4, and Walter F. Stewart PhD, MPH4

Affiliation of the authors: 1 Geisinger Health System, Danville, PA; EHR Safety Institute, Danville, PA ; 2 Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI; Center for Quality and Productivity Improvement, University of Wisconsin, Madison, WI ; 3 Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA; Engineering Systems Division, Massachusetts Institute of Technology, Cambridge, MA; Complex Systems Research Lab, Massachusetts Institute of Technology, Cambridge, MA ; 4 Geisinger Health System, Danville, PA; 5 American College of Physicians, Philadelphia, PA; 6 Clinical Information Systems, Kaiser Permanente Northwest Region, Portland, OR

* To whom correspondence should be addressed.

Diverse stakeholders-clinicians, researchers, business leaders, policy makers, and the public-have good reason to believe that the effective use of electronic healthcare records (EHRs) is essential to meaningful advances in healthcare quality and patient safety. However, several reports have documented the potential of EHRs to contribute to healthcare-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 healthcare-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.






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