Electronic health records and national patient-safety goals

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This is a review of Sittig and Singh's 2012 NEJM article "Electronic Health Records and National Patient-Safety Goals." [1]


EHRs have been widely implemented since the US government incentivized their use in 2009, but this widespread and rapid implementation has been extremely heterogeneous across health care organizations, meaning that many organizations are in various stages of implementing and using EHRs. This heterogeneity of EHR use has variable implications for patient safety, and Sittig and Singh proposed a 3-phase framework for addressing EHR-related patient safety across organizations with all levels of EHR implementation and use.


Phase 1: Address Safety Concerns Unique to EHR Technology

It is first important to make sure that EHR technology is safe (from things like device failures due to man-made or natural disasters and from miscommunications/erroneous transfers of information that could occur between system components). Potential electronic or "e" patient safety goals (PSGs) would be to "reduce the effect of EHR downtime on clinical operations and patient safety" and to reduce "the miscommunication of data transmitted between different safety-critical components of the EHR."[1]

Phase 2: Mitigate Safety Concerns Arising from Failure to use EHRs Appropriately

The second phase describes the necessity of using EHRs safely. This means ensuring that systems such as computerized provider order entry (CPOE) are ubiquitously implemented, that clinical decision support (CDS) is in use and effective, and that appropriate data exists in structured/coded form in the EHR. For this phase, ePSGs could be "mandate the use of CPOE for all medication orders, laboratory tests, and radiologic tests," "reduce alert fatigue," and ensure "critical data on medications, allergies, diagnostic test results, and clinical problems are entered as structured or coded data in the EHR."[1]

Phase 3: Use EHRs to Monitor and Improve Patient Safety

The third phase posits that once EHRs are known to be safe and can be used safely, health care organizations should move towards using them to measure and monitor safety in a health care system. An ePSG for this phase would be use the EHR to "monitor, identify, and report potential safety issues and events."[1]

Related Reference

Electronic health record-based triggers to detect potential delays in cancer diagnosis

Application of Framework

Every health care organization or system should assess which phase of this model they fall in and focus on the goals of that phase, with the eventual goal of moving through all three phases.


It is essential to "improve health care safety in the context of technology use."[1] We must also adopt National EHR-related patient safety goals to hold organizations and vendors accountable.


This article emphasizes the importance of not only using health information technology (specifically, EHRs) correctly, but also moving to a "next level" where these systems are able to measure and monitor safety events, whether they are EHR-related or not. Though this article was published 3 years ago, little seems to have changed in terms of EHR's/health care organizations' capabilities of doing this in that time. We must aspire to not only use EHRs for safety of medical practices, such as by using CPOE with CDS, but also towards using the abundant data they collect to influence and improve safety of the system as a whole.


  1. 1.0 1.1 1.2 1.3 1.4 Sittg DF and Singh H. N Engl J Med. 2012 Nov 8;367(19):1854-60. doi: 10.1056/NEJMsb1205420. http://www.ncbi.nlm.nih.gov/pubmed/23134389