Hospitals in pursuit of excellence

Electronic Health Records and National Patient-Safety Goals

Electronic Health Records implementation is still highly heterogeneous across health care systems and providers, and this heterogeneity leads to equally variable implications for patient safety. For instance, the priorities for patient safety in an organization in the midst of an EHR rollout differ from those of an organization that has used a fully integrated EHR system for 5 or more years. To account for the variation in the stages of implementation and levels of complexity across clinical practice settings, we propose a three-phase framework for the development of EHR-specific patient-safety goals. The first phase of the framework, aimed at all EHR users but especially at recent and future adopters, includes goals to mitigate risks that are unique and specific to technology14 (e.g., technology that is unsafe owing to unavailable or malfunctioning hardware or software). The second phase addresses issues created by the failure to use technology appropriately or by misuse of technology.15 The final phase focuses on the use of technology to monitor health care processes and outcomes and identify potential safety issues before they can harm patients.16 This framework can lay the foundation for the development of e-PSGs within the context of EHR-enabled health care.