May 2012

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Recent national incentives have focused on the expansion of health information technology, including electronic health records (EHRs) as a way to address costs, improve quality, reduce medical errors and ameliorate other dysfunctional aspects of the United States health care delivery system. However, the design, implementation and use of EHRs are complex. Some EHRs may incorporate features that are intended to improve patient safety but may not actually do so. In other instances, EHRs may introduce new errors or types of errors that detract from patient safety. Thus, it would be beneficial for organizations and clinicians to become aware of evidence-based practices for improving existing EHRs and enhancing overall safety for patients. At the core of this project is a systematic review of the literature, which is intended to identify evidence on facets of existing EHRs that can influence patient safety. A comprehensive search was conducted for the years 1990 to 2010 of the following databases: MEDLINE (PubMed); CINAHL, Computer Source, Computers and Applied Sciences, Library, Information Science and Technology Abstracts (EBSCO Host); ISI Web of Knowledge; Cochrane (Wiley); Compendex - Engineering Village; IEEE Xplore and Scopus. Titles and abstracts for 39952 citations were screened for relevance to the topic of EHRs and patient safety by the project author. No specific types of study designs were excluded a priori. On this basis, 1704 articles were identified for further review of which full text was available for 1403 articles. Of these references, 49 examined the effects of a modification to an existing EHR that was intended to have direct or indirect benefits for patient safety. Although a systematic search was not done for 2011 or 2012, 8 additional relevant studies from those years were identified during the completion of the project. No studies were able to be located that were aimed at minimizing new risks that may be associated with EHRs as compared to paper records. Data extraction and synthesis were done by the project author. The quality of individual studies was assessed using the recommendations of the Agency for Healthcare Research and Quality (AHRQ) for conducting systematic reviews. Due to the heterogeneity of study designs, no meta-analyses were done. Estimates of the strengths and limitations on the body of evidence relating to key topics were also done by the project author using AHRQ methodological recommendations. The results of this systematic review provide strong support for incorporating alerts to improve prescribing for geriatric patients. A substantial number of well-designed studies also suggest that venous thromboembolism (VTE) related decision support is beneficial but data from weaker trials is less consistent. More limited support exists for alerts to improve prescribing in other subgroups of patients such as individuals with impaired renal function. Additional aspects of EHRs that are been widely assumed to contribute to patient safety have not been as well-studied and would benefit from further research. In addition, studies are needed to determine the best approaches for addressing the new types of errors that have arisen with EHR use.




School of Medicine



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.