The Evidence Shows IOM Was Right on Health IT and Patient Safety

The potential for health IT to reduce errors has been a pillar of health policy on patient safety since the Institute of Medicine’s To Err is Human (2000) and Crossing the Quality Chasm (2001).  In 2012, in Health IT and Patient Safety: Building Safer Systems for Better Care the IOM found the evidence on the impact of health IT on patient safety was “mixed.”  Since then, whether health IT actually improves patient safety has remained an open question.

The nation has seen widespread adoption of health IT as a result of the Medicare and Medicaid EHR Incentive Programs.  With that increase in adoption, there should be more and better evidence on the actual impact of health IT on safety.  Health IT should raise the floor on patient safety, and the evidence shows that it has.

ONC “Issue Brief” looks at evidence on health IT safety

To help answer questions about the role health IT plays in patient safety, we recently posted an Issue Brief titled “Recent Evidence that Health IT Improves Patient Safety.”  On balance, the report found health IT has clearly made care safer. These studies mean that health IT has almost certainly led to far fewer people being harmed than would have been without widespread health IT adoption.  The Issue Brief reviews four systematic literature reviews that used a consistent methodology and finds consistent and significant net benefits on patient safety from the adoption of health IT.

The Issue Brief also identifies specific studies that show advanced health IT has reduced adverse events, medication errors, and procedure-related errors. One recent study also showed health IT has improved surgical safety.

The Issue Brief acknowledges and cites evidence on unintended consequences associated with health IT.   One study funded by the Agency for Healthcare Research and Quality found that adverse drug events increased 14 percent in hospitals reporting resistance to the “meaningful use” incentive program, while they declined 52 percent in hospitals where physicians accepted the program.  This is the first of four Issue Briefs on health IT and patient safety we expect to post by September 2015 through a contract with RTI International on a roadmap for a potential health IT safety center.

Institute of Medicine and Health IT in Redesigned Systems of Care

To add perspective, it’s useful to recall that in 2000 the IOM promoted health IT as part of “redesigned systems of care.” The IOM found that the large number of avoidable deaths identified in To Err is Human could not be decreased by trying harder in the same old (paper-based) healthcare system. The IOM explained, “Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.”

Health IT is not and never will be a “silver bullet” that reduces unsafe conditions, errors, and adverse events. To improve safety and quality, health IT is an important part of delivery system reform and redesigned systems of care. Health IT, when well designed and implemented, is a tool that can help health information flow in ways that allow for improvements in patient health and safety. Whatever the drawbacks to health IT systems, the evidence suggests that health IT has raised the floor on safety. At ONC, we are committed to working with clinicians, health care organizations, and health IT developers who share a commitment to making care safer and better by continuously improving the safety and safe use of health IT.

It is good to know that the evidence, so far, suggests that the IOM was right back in 2000. We should be going down this path. The widespread adoption of health IT has been a clear benefit to patient safety. We need to continue to work on making health IT even better in a redesigned health system with patient safety and quality its first priority.


  1. MB says:

    Its unfortunate that ONC is so tone deaf to front line EPs. The current crop of EHRs are spending every dollar to get MU certified and be a billing machine. In fact, nearly al EHRs predate any practical clinical IT system. The clinical system is kinda slapped on as an after thought to the mainstay of billing and MU cert. So when ONC talks about safety, they are light years behind. They don’t even understand the initial problem. We need ONC to get out of the certification business and the one size fits none measures and objectives and all the other MU hurdles in our way. A perfect example is our hospital EHR implemented a “sepsis alert” which of course we did not need, as we did not miss any septic patients. It was implemented under the guise of patient safety but its really a billing module so they can up-charge the visit. To make matters worse, the alert fired way too often when the patient was obviously not septic, too many false positives. We had to turn it off because it was firing way too often. Now is that a patient safety issue? The patient gets a septic alert and then a whole host of orders fire off, with unnecessary tests, antibiotics, labs, transfers, etc.

    When we asked our EHR to let us know if we send a culture of a infection, that if the antibiotics we have them on prior to the susceptibility results do not cover the final result, could it send us an alert that the patient is not on an antibiotic that the bacteria is sensitive. The answer, no. Now wouldn’t that be nice? As soon as we know the bacteria and susceptibilities, it makes sure the patient is on appropriate antibiotics? See we can’t bill for that, no money in that, just improved care, and that doesn’t count. If it improved a billing code or DRG then of course that is possible.

    That is just one example. I would argue that the current crop of EHRs actually WORSEN patient care and safety as the litany of popups and clicks have fatigued us to the point of ignoring every one. We need actually EPs on ONC that practice in the current EHR environment that understand the real street level front line problems we have with EHRs and patient safety.

  2. Jorge Ferrer says:

    The IOM in 1991 wrote The Computer-Based Patient Record An Essential Technology for Health Care. Many of the health IT policy directives were written in that book over 24 yrs. ago.

    Jorge A. Ferrer M.D., M.B.A
    Medical Informatician
    Adjunct Assistant Professor
    UTHealth School of Biomedical Informatics

  3. Jorge says:

    Some article from eGEMS focused on the topic.

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