FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 348:2526-2534 June 19, 2003 Number 25 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Editorial by Berwick, D. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

Health care is growing increasingly complex, and most clinical research focuses on new approaches to diagnosis and treatment. In contrast, relatively little effort has been targeted at the perfection of operational systems, which are partly responsible for the well-documented problems with medical safety.¹ If medicine is to achieve major gains in quality, it must be transformed, and information technology will play a key part,² especially with respect to safety.

In other industries, information technology has made possible what has been called "mass customization" — the efficient and reliable production of goods and services according to the highly personalized needs of . . . [Full Text of this Article]

Ways That Information Technology Can Reduce Errors

Improving Communication

Providing Access to Information

Requiring Information and Assisting with Calculations

Monitoring

Decision Support

Rapid Response to and Tracking of Adverse Events

Medication Safety and the Prevention of Errors

Summary of Approaches to Prevention

Barriers and Directions for Improvement

Financial Barriers

Lack of Standards

Cultural Barriers

Current Situation

Conclusions

Source Information

From the Division of General Medicine and Primary Care, Department of Medicine (D.W.B.), and the Department of Surgery (A.A.G.), Brigham and Women's Hospital; the Center for Applied Medical Information Systems, Partners HealthCare System (D.W.B.); and Harvard Medical School (D.W.B., A.A.G.) — all in Boston.

Address reprint requests to Dr. Bates at the Division of General Medicine and Primary Care, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at dbates@partners.org.

This article has been cited by other articles:

• Coombes, I D, Stowasser, D A, Reid, C, Mitchell, C A (2009). Impact of a standard medication chart on prescribing errors: a before-and-after audit. Qual Saf Health Care 18: 478-485 [Abstract] [Full Text]  
• Prgomet, M., Georgiou, A., Westbrook, J. I (2009). The Impact of Mobile Handheld Technology on Hospital Physicians' Work Practices and Patient Care: A Systematic Review. J Am Med Inform Assoc 16: 792-801 [Abstract] [Full Text]  
• Wachter, R. M., Pronovost, P. J. (2009). Balancing "No Blame" with Accountability in Patient Safety. NEJM 361: 1401-1406 [Full Text]  
• Piazza, G., Goldhaber, S. Z. (2009). Computerized Decision Support for the Cardiovascular Clinician: Applications for Venous Thromboembolism Prevention and Beyond. Circulation 120: 1133-1137 [Full Text]  
• Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I. B., Inzucchi, S. E., Ismail-Beigi, F., Kirkman, M. S., Umpierrez, G. E. (2009). American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care 32: 1119-1131 [Full Text]  
• Rinfret, S., Lussier, M.-T., Peirce, A., Duhamel, F., Cossette, S., Lalonde, L., Tremblay, C., Guertin, M.-C., LeLorier, J., Turgeon, J., Hamet, P., for the LOYAL Study Investigators, (2009). The Impact of a Multidisciplinary Information Technology-Supported Program on Blood Pressure Control in Primary Care. Circ Cardiovasc Qual Outcomes 2: 170-177 [Abstract] [Full Text]  
• Piazza, G., Rosenbaum, E. J., Pendergast, W., Jacobson, J. O., Pendleton, R. C., McLaren, G. D., Elliott, C. G., Stevens, S. M., Patton, W. F., Dabbagh, O., Paterno, M. D., Catapane, E., Li, Z., Goldhaber, S. Z. (2009). Physician Alerts to Prevent Symptomatic Venous Thromboembolism in Hospitalized Patients. Circulation 119: 2196-2201 [Abstract] [Full Text]  
• Coiera, E, Braithwaite, J (2009). Market-based control mechanisms for patient safety. Qual Saf Health Care 18: 99-103 [Abstract] [Full Text]  
• Piva, E., Sciacovelli, L., Zaninotto, M., Laposata, M., Plebani, M. (2009). Evaluation of Effectiveness of a Computerized Notification System for Reporting Critical Values. Am J Clin Pathol 131: 432-441 [Abstract] [Full Text]  
• van Doormaal, J E, van den Bemt, P M L A, Mol, P G M, Zaal, R J, Egberts, A C G, Haaijer-Ruskamp, F M, Kosterink, J G W (2009). Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients. Qual Saf Health Care 18: 22-27 [Abstract] [Full Text]  
• Amarasingham, R., Plantinga, L., Diener-West, M., Gaskin, D. J., Powe, N. R. (2009). Clinical Information Technologies and Inpatient Outcomes: A Multiple Hospital Study. Arch Intern Med 169: 108-114 [Abstract] [Full Text]  
• Spooner, S. A., Classen, D. C. (2009). Data Standards and Improvement of Quality and Safety in Child Health Care. Pediatrics 123: S74-S79 [Abstract] [Full Text]  
• Egger Halbeis, C. B., Epstein, R. H., Macario, A., Pearl, R. G., Grunwald, Z. (2008). Adoption of Anesthesia Information Management Systems by Academic Departments in the United States. Anesth. Analg. 107: 1323-1329 [Abstract] [Full Text]  
• Sturgeon, C. M., Hoffman, B. R., Chan, D. W., Ch'ng, S.-L., Hammond, E., Hayes, D. F., Liotta, L. A., Petricoin, E. F., Schmitt, M., Semmes, O. J., Soletormos, G., van der Merwe, E., Diamandis, E. P. (2008). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Clinical Practice: Quality Requirements. Clin. Chem. 54: e1-e10 [Abstract] [Full Text]  
• Kilbridge, P. M, Classen, D. C (2008). The Informatics Opportunities at the Intersection of Patient Safety and Clinical Informatics. J Am Med Inform Assoc 15: 397-407 [Abstract] [Full Text]  
• Schnipper, J. L, Linder, J. A, Palchuk, M. B, Einbinder, J. S, Li, Q., Postilnik, A., Middleton, B. (2008). "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management. J Am Med Inform Assoc 15: 513-523 [Abstract] [Full Text]  
• Grant, R. W. (2008). Next Generation of Health Information Tools: Where Do We Go From Here?. Mayo Clin Proc. 83: 745-746 [Full Text]  
• Staes, C. J, Evans, R S., Rocha, B. H S C, Sorensen, J. B, Huff, S. M, Arata, J., Narus, S. P (2008). Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients. J Am Med Inform Assoc 15: 324-332 [Abstract] [Full Text]  
• Nepple, K. G., Joudi, F. N., Hillis, S. L., Wahls, T. L. (2008). Prevalence of Delayed Clinician Response to Elevated Prostate-Specific Antigen Values. Mayo Clin Proc. 83: 439-445 [Abstract] [Full Text]  
• Glickman, S. W., Baggett, K. A., Krubert, C. G., Peterson, E. D., Schulman, K. A. (2007). Promoting quality: the health-care organization from a management perspective. Int J Qual Health Care 19: 341-348 [Abstract] [Full Text]  
• Singh, H., Thomas, E. J., Petersen, L. A., Studdert, D. M. (2007). Medical Errors Involving Trainees: A Study of Closed Malpractice Claims From 5 Insurers. Arch Intern Med 167: 2030-2036 [Abstract] [Full Text]  
• Lo, H. G, Newmark, L. P, Yoon, C., Volk, L. A, Carlson, V. L, Kittler, A. F, Lippincott, M., Wang, T., Bates, D. W (2007). Electronic Health Records in Specialty Care: A Time-Motion Study. J Am Med Inform Assoc 14: 609-615 [Abstract] [Full Text]  
• Cresswell, K. M., Fernando, B., McKinstry, B., Sheikh, A. (2007). Adverse drug events in the elderly. Br Med Bull 83: 259-274 [Abstract] [Full Text]  
• Shields, A. E., Shin, P., Leu, M. G., Levy, D. E., Betancourt, R. M., Hawkins, D., Proser, M. (2007). Adoption Of Health Information Technology In Community Health Centers: Results Of A National Survey. Health Aff (Millwood) 26: 1373-1383 [Abstract] [Full Text]  
• Barber, N., Cornford, T., Klecun, E. (2007). Qualitative evaluation of an electronic prescribing and administration system. Qual Saf Health Care 16: 271-278 [Abstract] [Full Text]  
• Pierson, S., Hansen, R., Greene, S., Williams, C., Akers, R., Jonsson, M., Carey, T. (2007). Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. Qual Saf Health Care 16: 297-302 [Abstract] [Full Text]  
• Singh, H., Arora, H. S, Vij, M. S, Rao, R., Khan, M. M, Petersen, L. A (2007). Communication Outcomes of Critical Imaging Results in a Computerized Notification System. J Am Med Inform Assoc 14: 459-466 [Abstract] [Full Text]  
• Amarasingham, R., Pronovost, P. J, Diener-West, M., Goeschel, C., Dorman, T., Thiemann, D. R, Powe, N. R (2007). Measuring Clinical Information Technology in the ICU Setting: Application in a Quality Improvement Collaborative. J Am Med Inform Assoc 14: 288-294 [Abstract] [Full Text]  
• Crosson, J. C., Ohman-Strickland, P. A., Hahn, K. A., DiCicco-Bloom, B., Shaw, E., Orzano, A. J., Crabtree, B. F. (2007). Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices. Ann Fam Med 5: 209-215 [Abstract] [Full Text]  
• Stebbing, C., Wong, I. C K, Kaushal, R., Jaffe, A. (2007). The role of communication in paediatric drug safety. Arch. Dis. Child. 92: 440-445 [Abstract] [Full Text]  
• de Wildt, S. N, Verzijden, R., Anker, J. N v. d., de Hoog, M. (2007). Information technology cannot guarantee patient safety. BMJ 334: 851-852 [Full Text]  
• Osheroff, J. A, Teich, J. M, Middleton, B., Steen, E. B, Wright, A., Detmer, D. E (2007). A Roadmap for National Action on Clinical Decision Support. J Am Med Inform Assoc 14: 141-145 [Abstract] [Full Text]  
• Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., Baker, D. W. (2007). Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care. JAMA 297: 831-841 [Abstract] [Full Text]  
• Vincent, C. (2007). Incident reporting and patient safety. BMJ 334: 51-51 [Full Text]  
• Tang, P. C, Ralston, M., Arrigotti, M. F., Qureshi, L., Graham, J. (2007). Comparison of Methodologies for Calculating Quality Measures Based on Administrative Data versus Clinical Data from an Electronic Health Record System: Implications for Performance Measures. J Am Med Inform Assoc 14: 10-15 [Abstract] [Full Text]  
• Kuperman, G. J, Bobb, A., Payne, T. H, Avery, A. J, Gandhi, T. K, Burns, G., Classen, D. C, Bates, D. W (2007). Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review. J Am Med Inform Assoc 14: 29-40 [Abstract] [Full Text]  
• Classen, D. C, Avery, A. J, Bates, D. W (2007). Evaluation and Certification of Computerized Provider Order Entry Systems. J Am Med Inform Assoc 14: 48-55 [Abstract] [Full Text]  
• Rothschild, J. M, Fang, E., Liu, V., Litvak, I., Yoon, C., Bates, D. W (2006). Use and Perceived Benefits of Handheld Computer-based Clinical References. J Am Med Inform Assoc 13: 619-626 [Abstract] [Full Text]  
• Veazie, P. J. (2006). An individual-based framework for the study of medical error. Int J Qual Health Care 18: 314-319 [Abstract] [Full Text]  
• Blumenthal, D. (2006). Employer-sponsored health insurance in the United States--origins and implications.. NEJM 355: 82-88 [Full Text]  
• Judge, J., Field, T. S, DeFlorio, M., Laprino, J., Auger, J., Rochon, P., Bates, D. W, Gurwitz, J. H (2006). Prescribers' Responses to Alerts During Medication Ordering in the Long Term Care Setting. J Am Med Inform Assoc 13: 385-390 [Abstract] [Full Text]  
• Young, D., Griffiths, J. (2006). Clinical trials of monitoring in anaesthesia, critical care and acute ward care: a review. Br J Anaesth 97: 39-45 [Abstract] [Full Text]  
• Lapointe, L., Rivard, S. (2006). Getting physicians to accept new information technology: insights from case studies.. CMAJ 174: 1573-1578 [Abstract] [Full Text]  
• Gurses, A. P, Xiao, Y. (2006). A Systematic Review of the Literature on Multidisciplinary Rounds to Design Information Technology. J Am Med Inform Assoc 13: 267-276 [Abstract] [Full Text]  
• Sox, C. M., Koepsell, T. D., Doctor, J. N., Christakis, D. A. (2006). Pediatricians' Clinical Decision Making: Results of 2 Randomized Controlled Trials of Test Performance Characteristics. Arch Pediatr Adolesc Med 160: 487-492 [Abstract] [Full Text]  
• Parra, D., Woods, D., Balu, V., Coakley, R. (2006). Excess dosing of antithrombotic therapy in non-ST-segment elevation acute coronary syndromes.. JAMA 295: 1897-1897 [Full Text]  
• Hersh, W. (2006). Who are the Informaticians? What We Know and Should Know. J Am Med Inform Assoc 13: 166-170 [Abstract] [Full Text]  
• Royal, S, Smeaton, L, Avery, A J, Hurwitz, B, Sheikh, A (2006). Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care 15: 23-31 [Abstract] [Full Text]  
• Ray, W. A., Stein, C. M. (2006). Reform of Drug Regulation -- Beyond an Independent Drug-Safety Board. NEJM 354: 194-201 [Full Text]  
• Wolbarst, A. B., Hendee, W. R. (2006). Evolving and Experimental Technologies in Medical Imaging. Radiology 238: 16-39 [Abstract] [Full Text]  
• Longo, D. R., Hewett, J. E., Ge, B., Schubert, S. (2005). The Long Road to Patient Safety: A Status Report on Patient Safety Systems. JAMA 294: 2858-2865 [Abstract] [Full Text]  
• Samore, M. H., Bateman, K., Alder, S. C., Hannah, E., Donnelly, S., Stoddard, G. J., Haddadin, B., Rubin, M. A., Williamson, J., Stults, B., Rupper, R., Stevenson, K. (2005). Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial. JAMA 294: 2305-2314 [Abstract] [Full Text]  
• Savage, S. W., Schneider, P. J., Pedersen, C. A. (2005). Utility of an online medication-error-reporting system. Am J Health Syst Pharm 62: 2265-2270 [Abstract] [Full Text]  
• (2005). American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States. Am. J. Respir. Crit. Care Med. 172: 1169-1227 [Full Text]  
• Boudville, N. (2005). The predictable effect that renal failure has on H2 receptor antagonists--increasing the half-life along with increasing prescribing errors. Nephrol Dial Transplant 20: 2315-2317 [Full Text]  
• Mattana, J., Charitou, M., Mills, L., Baskin, C., Steinberg, H., Tu, C., Kerpen, H. (2005). Personal Digital Assistants: A Review of Their Application in Graduate Medical Education. American Journal of Medical Quality 20: 262-267 [Abstract]  
• Pukk, K., Aron, D. C. (2005). The DNA damage response and patient safety: engaging our molecular biology-oriented colleagues. Int J Qual Health Care 17: 363-367 [Abstract] [Full Text]  
• Nelson, N. C, Evans, R S., Samore, M. H, Gardner, R. M (2005). Detection and Prevention of Medication Errors Using Real-Time Bedside Nurse Charting. J Am Med Inform Assoc 12: 390-397 [Abstract] [Full Text]  
• Morris, C J, Savelyich, B S P, Avery, A J, Cantrill, J A, Sheikh, A (2005). Patient safety features of clinical computer systems: questionnaire survey of GP views. Qual Saf Health Care 14: 164-168 [Abstract] [Full Text]  
• Cohen, M M, Kimmel, N L, Benage, M K, Cox, M J, Sanders, N, Spence, D, Chen, J (2005). Medication safety program reduces adverse drug events in a community hospital. Qual Saf Health Care 14: 169-174 [Abstract] [Full Text]  
• Garland, A. (2005). Improving the ICU: Part 2. Chest 127: 2165-2179 [Abstract] [Full Text]  
• Leape, L. L., Berwick, D. M. (2005). Five Years After To Err Is Human: What Have We Learned?. JAMA 293: 2384-2390 [Abstract] [Full Text]  
• Schiff, G. D., Kim, S., Krosnjar, N., Wisniewski, M. F., Bult, J., Fogelfeld, L., McNutt, R. A. (2005). Missed Hypothyroidism Diagnosis Uncovered by Linking Laboratory and Pharmacy Data. Arch Intern Med 165: 574-577 [Abstract] [Full Text]  
• Kucher, N., Koo, S., Quiroz, R., Cooper, J. M., Paterno, M. D., Soukonnikov, B., Goldhaber, S. Z. (2005). Electronic Alerts to Prevent Venous Thromboembolism among Hospitalized Patients. NEJM 352: 969-977 [Abstract] [Full Text]  
• Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., Strom, B. L. (2005). Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA 293: 1197-1203 [Abstract] [Full Text]  
• Wilson, J. W., Oyen, L. J., Ou, N. N., McMahon, M. M., Thompson, R. L., Manahan, J. M., Graner, K. K., Lovely, J. K., Estes, L. L. (2005). Hospital rules-based system: The next generation of medical informatics for patient safety. Am J Health Syst Pharm 62: 499-505 [Abstract] [Full Text]  
• Hall, M. A., Peeples, R. A., Lord, R. W. Jr (2005). Liability Implications of Physician-Directed Care Coordination. Ann Fam Med 3: 115-121 [Abstract] [Full Text]  
• Goldhaber, S. Z., Turpie, A. G.G. (2005). Prevention of Venous Thromboembolism Among Hospitalized Medical Patients. Circulation 111: e1-e3 [Full Text]  
• Ash, J. S, Bates, D. W (2005). Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion. J Am Med Inform Assoc 12: 8-12 [Abstract] [Full Text]  
• Middleton, B., Hammond, W E., Brennan, P. F, Cooper, G. F (2005). Accelerating U.S. EHR Adoption: How to Get There From Here. Recommendations Based on the 2004 ACMI Retreat. J Am Med Inform Assoc 12: 13-19 [Abstract] [Full Text]  
• Thrall, J. H. (2004). The Emerging Role of Pay-for-Performance Contracting for Health Care Services. Radiology 233: 637-640 [Full Text]  
• Hersh, W. (2004). Health Care Information Technology: Progress and Barriers. JAMA 292: 2273-2274 [Full Text]  
• Hsieh, T. C, Kuperman, G. J, Jaggi, T., Hojnowski-Diaz, P., Fiskio, J., Williams, D. H, Bates, D. W, Gandhi, T. K (2004). Characteristics and Consequences of Drug Allergy Alert Overrides in a Computerized Physician Order Entry System. J Am Med Inform Assoc 11: 482-491 [Abstract] [Full Text]  
• Finegan, B. A. (2004). Access Denied; Care Impaired: The Benefits of Having Online Medical Information Available at the Point-of-Care. Anesth. Analg. 99: 1450-1452 [Abstract] [Full Text]  
• Gurwitz, J. H. (2004). Polypharmacy: A New Paradigm for Quality Drug Therapy in the Elderly?. Arch Intern Med 164: 1957-1959 [Full Text]  
• Karsh, B-T (2004). Beyond usability: designing effective technology implementation systems to promote patient safety. Qual Saf Health Care 13: 388-394 [Abstract] [Full Text]  
• Martin, P., Haefeli, W. E, Martin-Facklam, M. (2004). A Drug Database Model as a Central Element for Computer-Supported Dose Adjustment within a CPOE System. J Am Med Inform Assoc 11: 427-432 [Abstract] [Full Text]  
• Morimoto, T, Gandhi, T K, Seger, A C, Hsieh, T C, Bates, D W (2004). Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care 13: 306-314 [Abstract] [Full Text]  
• Jewell, M. L (2004). Patient Safety Data: How it Can Improve Our Performance. Aesthetic Surgery Journal 24: 346-348 [Full Text]  
• Sellman, J. S, Decarolis, D., Schullo-Feulner, A., Nelson, D. B, Filice, G. A (2004). Information Resources Used in Antimicrobial Prescribing. J Am Med Inform Assoc 11: 281-284 [Abstract] [Full Text]  
• Yasnoff, W. A, Humphreys, B. L, Overhage, J M., Detmer, D. E, Brennan, P. F., Morris, R. W, Middleton, B., Bates, D. W, Fanning, J. P (2004). A Consensus Action Agenda for Achieving the National Health Information Infrastructure. J Am Med Inform Assoc 11: 332-338 [Abstract] [Full Text]  
• Brasel, K. J., Pierre, A. L., Weigelt, J. A. (2004). Resident Work Hours: What They Are Really Doing. Arch Surg 139: 490-494 [Abstract] [Full Text]  
• Jones, M. D. Jr. (2004). More Than a Matter of Time. Pediatrics 113: 1396-1398 [Full Text]  
• Epstein, A. M., Lee, T. H., Hamel, M. B. (2004). Paying Physicians for High-Quality Care. NEJM 350: 406-410 [Full Text]  
• Dracup, K., Bryan-Brown, C. W. (2003). Nursing Morbidity and Mortality Conferences. Am J Crit Care 12: 492-494 [Full Text]  
• Ramnarayan, P, Steel, E., Britto, J. (2003). Sharing patient information electronically throughout NHS: Ability to provide seamless decision support will be key factor. BMJ 327: 623-623 [Full Text]  
• Doarn, C. R. (2003). Telemedicine in Tomorrow's Operating Room: A Natural Fit. SURG INNOV 10: 121-126 [Abstract]  
• Berwick, D. M. (2003). Errors Today and Errors Tomorrow. NEJM 348: 2570-2572 [Full Text]