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Reflections on Safety is a monthly column presenting the insights of Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI). Dr. Gandhi was president and CEO of the National Patient Safety Foundation prior to its merger with IHI in May 2017.


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Health IT: The Evolution Continues

Posted By Administration, Tuesday, July 8, 2014
Updated: Tuesday, September 2, 2014
By Tejal K. Gandhi, MD, MPH, CPPS
 Dr. Tejal Gandhi
Although health care lagged behind other industries in the widespread adoption of information technology, in recent years, and partly thanks to the federal HITECH act, health information technology (HIT) has evolved rapidly. There are good studies that show the benefits of health IT, and implementation is meant to benefit patients and providers alike. However, we must remember that every new technology potentially introduces new problems. Studies have now been done showing the potential pitfalls of HIT, and a key issue in patient safety is ensuring ways to maximize the benefits and minimize the unintended consequences and hazards.


Greater awareness of these unintended consequences has, in turn, led to broader discussions at the national level. Both the Institute of Medicine (2012) and the Office of the National Coordinator for Health IT (ONC) (2013) have issued reports highlighting the challenges of risk mitigation with health IT and the need to develop better methods for hazard identification and best practice development and dissemination. Recent efforts (such as the ECRI Collaborative on Health IT Safety and the Health IT Safety Summit hosted by the Alliance for Quality Improvement and Patient Sagety (AQIPS) have focused on developing mechanisms for health care systems, industry, and patient safety organizations (PSOs) to be better able to collect, aggregate, and analyze HIT hazard data. In addition, ONC funded the creation of the SAFER guides, tools to help organizations implement HIT more safely.


Earlier this year, as required by the Food and Drug Administration Safety and Innovation Act of 2012 (FDASIA), the FDA, ONC, and Federal Communications Commission jointly released a report that made recommendations about how oversight of HIT should be organized, as well as recommending the creation of a Health IT Safety Center. This public-private entity would convene stakeholders in order to focus on activities that promote health IT as an integral part of patient safety, with the goal of creating a health IT learning system in order to better understand HIT hazards and identify and disseminate best practices.  The public comment period on the FDASIA strategy ended earlier this week, so the outcome remains to be seen, but there is no question that more attention will be focused on this area in the coming years.


In the meantime, work is being done to evaluate how we got to where we are in the evolution of health IT. Dr. Bob Wachter, currently on sabbatical from his job as professor and associate chairman of the Department of Medicine at the University of California, San Francisco, is working on a book that will look at how information technology has “disrupted” health care—and how we might move beyond today’s challenges to achieve the innovation that medicine needs. Dr. Wachter, a member of the NPSF Lucian Leape Institute, will be the keynote speaker at the 7th Annual NPSF Lucian Leape Institute Forum & Gala this September in Boston. We very much look forward to his talk, and we’ll be sure to report on it in this column.


We are moving rapidly on the health IT adoption curve, and I am confident of the benefits that can be attained for patient safety—through the use of clinical decision support, clinical documentation, test result management, and other safety features. However, we will need to be ever vigilant for new safety hazards that may arise either from hardware and software, or from implementation challenges related to workflow, policies and procedures, and regulatory requirements. Familiarity with best practices for implementation to optimize safety benefit is an area that all patient safety professionals will need to become more proficient in, as these systems continue to gain more widespread use. 


Tejal K. Gandhi, MD, MPH, CPPS, is president of the National Patient Safety Foundation and president of the NPSF Lucian Leape Institute. She is also a member of the Health IT Policy Committee Safety Task  Force of the Office of the National Coordinator for Health IT.



Institute of Medicine. 2012. With Committee on Patient Safety and Health Information Technology, and Board on Health Care Services. Health IT and Patient Safety: Building Safer Systems for Better Care.Washington, DC: The National Academies Press. Available at:
Food and Drug Administration (FDA), Federal Communications Commission (FCC), and Office of the National Coordinator for Health Information Technology (ONC). 2014. FDASIA Health IT Report: Proposed Strategy and Recommendations for a Risk-Based Framework. Available at:
Office of the National Coordinator for Health Information Technology (ONC). 2013. Health Information Technology Patient Safety Action and Surveillance Plan. Available at:


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