June 2012

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Healthcare professionals aim to provide the best care possible, but in the worst situations, the healthcare provided sometimes causes harm to patients. In 1999, the Institute of Medicine published a landmark report titled, “To Err is Human” which claims that between 44,000 and 98,000 people die and more than a million are injured annually from preventable medical errors. One of the many recommendations from the report is to implement healthcare information systems (HIS) to ensure safety. Practitioners of medicine are increasingly utilizing HIS in their delivery of healthcare to patients. The benefits of using such systems include lowering costs, lowering medical errors and improving healthcare efficiency and quality (Carvalho et al., 2009; van Rosse et al., 2009). In a systematic review of Computer-based Provider Order Entry (CPOE) system usage, van Rosse et al. (2009) found that medication prescription errors were significantly reduced. However, researchers have shown that systems can generate a new kind of error, technology-induced or technology-facilitated errors (Carvalho et al., 2009; Koppel et al., 2005; Kushniruk et al., 2005). A term has been coined to describe this effect, which is “e-iatrogenesis”. E-iatrogenesis was defined in 2007 by Weiner et al. as “patient harm caused at least in part by the application of health information technology.” As healthcare information systems have grown in complexity, there are new opportunities for errors (Borycki and Kushniruk, 2008; Koppel et al., 2005). Palmieri et al. describe e-iatrogenesis as being the result of complex HIS innovation applied to the complex adaptive system of healthcare. In addition to generating new errors, it also can worsen existing problems in the healthcare delivery system (Palmieri et al., 2008). Thus, experts and government have recommended healthcare organizations to be considerate of safety issues when implementing HIS (Joint Commission, 2008). There have been calls for development of new ways to detect errors before system implementation and identification of the various situations and root causes for technology-induced errors to occur (Borycki and Keay, 2010). Other recommendations include better error reporting, HIS vendor transparency, more thorough testing and certification.




School of Medicine



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