National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Cancer (2)
- Care Coordination (1)
- Care Management (2)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (4)
- Communication (4)
- Community-Based Practice (2)
- Data (6)
- Diabetes (1)
- Diagnostic Safety and Quality (1)
- Disparities (1)
- (-) Electronic Health Records (EHRs) (34)
- Emergency Department (1)
- Healthcare Delivery (3)
- Health Information Exchange (HIE) (2)
- (-) Health Information Technology (HIT) (34)
- Health Services Research (HSR) (3)
- Heart Disease and Health (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (1)
- Medical Errors (1)
- Medication (1)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (4)
- Practice Patterns (4)
- Primary Care (6)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Physician (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality Measures (2)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
- Registries (2)
- Research Methodologies (1)
- Respiratory Conditions (1)
- Risk (1)
- Social Determinants of Health (1)
- Social Media (1)
- Vaccination (1)
- Web-Based (1)
- Workflow (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 34 Research Studies DisplayedRusso E, Sittig DF, Murphy DR
Challenges in patient safety improvement research in the era of electronic health records.
The researchers used a case study involving a project on missed or delayed follow-up of test results to discuss real-world challenges in using electronic health records data for patient safety research. They suggested that many current data access and security policies and procedures must be rewritten and standardized across health care organization sin order to advance progress toward safer health care.
AHRQ-funded; HS022901.
Citation: Russo E, Sittig DF, Murphy DR .
Challenges in patient safety improvement research in the era of electronic health records.
Healthc 2016 Dec;4(4):285-90. doi: 10.1016/j.hjdsi.2016.06.005.
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Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Health Information Technology (HIT), Patient Safety, Quality Improvement
Topaz M, Seger DL, Goss F
Standard information models for representing adverse sensitivity information in clinical documents.
This study aimed to identify and compare the existing common adverse sensitivity information models. Overall, the models had many similarities in the central attributes which covered between 75% and 95% of adverse sensitivity information contained within the notes. However, representations of some attributes (especially the value-sets) were not well aligned between the models, which is likely to present an obstacle for achieving data interoperability.
AHRQ-funded; HS022728.
Citation: Topaz M, Seger DL, Goss F .
Standard information models for representing adverse sensitivity information in clinical documents.
Methods Inf Med 2016;55(2):151-7. doi: 10.3414/me15-01-0081.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Fong A, Hoffman DJ, Zachary Hettinger A
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
The authors propose an algorithmic approach to identify different visual search patterns. They demonstrate this approach by identifying common physician visual search patterns using a simulated prototype emergency department patient tracking system. They then discuss the benefits and limitations as well as insights from this initial evaluation.
AHRQ-funded; HS020433.
Citation: Fong A, Hoffman DJ, Zachary Hettinger A .
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
J Am Med Inform Assoc 2016 Nov;23(6):1180-84. doi: 10.1093/jamia/ocv196.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow
Ramos SR, Gordon P, Bakken S
Sociotechnical analysis of health information exchange consent processes in an HIV clinic.
The purpose of this study was to describe sociotechnical factors that influence health information exchange (HIE) consent for persons living with HIV (PLWH) at one clinic in New York City. The authors' approach revealed multiple interruptions in clinical workflow, staff and providers' time constraints, and lack of dedicated personnel focused on HIE consent as the major barriers to HIE consent, and they recommended having a dedicated person for facilitating HIE consent.
AHRQ-funded; HS023963.
Citation: Ramos SR, Gordon P, Bakken S .
Sociotechnical analysis of health information exchange consent processes in an HIV clinic.
J Assoc Nurses AIDS Care 2016 Nov - Dec;27(6):792-803. doi: 10.1016/j.jana.2016.08.001.
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Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Human Immunodeficiency Virus (HIV)
Mazur LM, Mosaly PR, Moore C
Toward a better understanding of task demands, workload, and performance during physician-computer interactions.
The researchers assessed the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment. Two experiments were performed in 2 different electronic medical record environments: WebCIS and Epic. Results suggest that task demands as experienced by participants are related to participants' performance.
AHRQ-funded; HS023458; HS024062.
Citation: Mazur LM, Mosaly PR, Moore C .
Toward a better understanding of task demands, workload, and performance during physician-computer interactions.
J Am Med Inform Assoc 2016 Nov;23(6):1113-20. doi: 10.1093/jamia/ocw016.
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Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Provider Performance
Abramson EL, Patel V, Pfoh ER
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
The study objective was to examine how perceptions about using the new electronic health record (EHR) evolved over time, with focus on electronic prescribing. It found that for even experienced e-prescribers, achieving prior levels of perceived prescribing efficiency took nearly two years. Despite the fact that speed in performing prescribing-related tasks was highly important, most were still not utilizing system short cuts or customization features designed to maximize efficiency.
AHRQ-funded; R18 HS017029.
Citation: Abramson EL, Patel V, Pfoh ER .
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
Appl Clin Inform 2016 Oct 26;7(4):994-1006. doi: 10.4338/aci-2016-04-ra-0069.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Fulford D, Tuot DS, Mangurian C
Electronic psychiatric consultation in primary care in the safety net.
The authors examined the feasibility and acceptability of implementing a psychiatric eReferral program in a publicly funded, community-based primary care clinic in San Francisco staffed by eight primary care practitioners (PCPs). They found feasibility and acceptability of implementing an integrated electronic psychiatry consultation and referral service in a community-based primary care clinic and recommended future trials designed to examine the impact of this type of service on the delivery of high-quality mental health care and its cost-effectiveness in a safety-net health care system.
AHRQ-funded; HS021700.
Citation: Fulford D, Tuot DS, Mangurian C .
Electronic psychiatric consultation in primary care in the safety net.
Psychiatr Serv 2016 Oct;67(10):1160-61. doi: 10.1176/appi.ps.671003.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Behavioral Health, Primary Care, Health Information Technology (HIT)
Yazdany J, Myslinski R, Miller A
Methods for developing the American College of Rheumatology's electronic clinical quality measures.
The authors discuss the methodologic approach recommended by the American College of Rheumatology (ACR) to develop new electronic clinical quality measures (eCQMs) in priority areas. They recommend that the ACR’s eCQM development program evolve to address newly-identified gaps in care that are amenable to quality improvement and that input from rheumatologists continue to be a key ingredient for a measurement strategy that seeks not just to assess performance but to improve outcomes for patients.
AHRQ-funded; HS024412.
Citation: Yazdany J, Myslinski R, Miller A .
Methods for developing the American College of Rheumatology's electronic clinical quality measures.
Arthritis Care Res 2016 Oct;68(10):1402-9. doi: 10.1002/acr.22985.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Health Information Technology (HIT), Quality Measures, Quality Measures
Murphy DR, Meyer AN, Bhise V
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
A "trigger" algorithm was used to identify delays in follow-up of abnormal chest imaging results in a large national clinical data warehouse of electronic health record (EHR) data. In this study, the authors applied a trigger in a repository hosting EHR data from all Department of Veterans Affairs health-care facilities and analyzed data from seven facilities. The investigators concluded that application of triggers on "big" EHR data may aid in identifying patients experiencing delays in diagnostic evaluation of chest imaging results suspicious for malignancy.
Citation: Murphy DR, Meyer AN, Bhise V .
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
Chest 2016 Sep;150(3):613-20. doi: 10.1016/j.chest.2016.05.001..
Keywords: Imaging, Electronic Health Records (EHRs), Health Information Technology (HIT), Data, Diagnostic Safety and Quality, Cancer
Curtis JR, Harrold LR, Asgari MM
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
The authors sought to estimate the prevalence of axial spondyloarthritis (axSpA) and ankylosing spondylitis in Kaiser Permanente Northern California (KPNC). They found that observed prevalence in the KPNC population, compared with national estimates for axSpA and ankylosing spondylitis, suggests underrecognition of these conditions in routine clinical practice. They suggested the use of computerized data to identify true cases of ankylosing spondylitis in order to facilitate population-based research.
AHRQ-funded; HS021589; HS018517.
Citation: Curtis JR, Harrold LR, Asgari MM .
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
Perm J 2016 Fall;20(4):4-10. doi: 10.7812/tpp/15-151.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Practice Patterns
Ancker JS, Hafeez B, Kaushal R
Socioeconomic disparities in adoption of personal health records over time.
The authors sought to track personal health record (PHR) adoption and differences by sociodemographic group over time. Using data from the Empire State Poll, they found that during a 4-year period in which federal policies incentivized medical organizations to give medical record access to patients through PHRs and electronic portals, rates of PHR use increased rapidly in all sociodemographic groups, but with a digital divide remaining, linked to Hispanic ethnicity and lower income.
AHRQ-funded; HS021531.
Citation: Ancker JS, Hafeez B, Kaushal R .
Socioeconomic disparities in adoption of personal health records over time.
Am J Manag Care 2016 Aug;22(8):539-40.
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Keywords: Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Social Determinants of Health
Cato KD, Bockting W, Larson E
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
Using the Belmont Report's principles of respect for persons, beneficence, and justice as a framework, the authors examined the ethical issues posed by electronic phenotyping. Ethical issues identified include the ability of the patient to consent for the use of their information, the ability to suppress pediatric information, and ensuring that the potential benefits justify the risks of harm to patients.
AHRQ-funded; HS022961.
Citation: Cato KD, Bockting W, Larson E .
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
J Empir Res Hum Res Ethics 2016 Jul;11(3):214-9. doi: 10.1177/1556264616661611.
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Keywords: Clinician-Patient Communication, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Outcomes Research, Registries, Research Methodologies
Rizvi RF, Harder KA, Hultman GM
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
The researchers sought to understand physicians' usage of inpatient notes in two Electronic Health Record (EHR) systems. They found that the highest variability was observed with progress notes and the least variability was within discharge summaries, while note-writing styles were most consistent for history and physical notes. Physician preference for adopting a certain reading/retrieval order appeared to be a function of what best fits their workflow while fulfilling the stimulus demands. They also found that time spent entering history and physical, discharge summaries, and progress notes were similar in both EHRs.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Harder KA, Hultman GM .
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
Int J Med Inform 2016 Jun;90:1-11. doi: 10.1016/j.ijmedinf.2016.02.011.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel, Practice Patterns
Vock DM, Wolfson J, Bandyopadhyay S
Adapting machine learning techniques to censored time-to-event health record data: a general-purpose approach using inverse probability of censoring weighting.
In this paper, the authors present a general-purpose approach to account for right-censored outcomes using inverse probability of censoring weighting (IPCW). They illustrate how IPCW can easily be incorporated into a number of existing machine learning algorithms used to mine big health care data including Bayesian networks, k-nearest neighbors, decision trees, and generalized additive models.
AHRQ-funded; HS017622.
Citation: Vock DM, Wolfson J, Bandyopadhyay S .
Adapting machine learning techniques to censored time-to-event health record data: a general-purpose approach using inverse probability of censoring weighting.
J Biomed Inform 2016 Jun;61:119-31. doi: 10.1016/j.jbi.2016.03.009.
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Keywords: Data, Electronic Health Records (EHRs), Health Information Technology (HIT)
Dugas AF, Kirsch TD, Toerper M
An electronic emergency triage system to improve patient distribution by critical outcomes.
This study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes. The authors found improved differentiation of patients compared to the current standard Emergency Severity Index.
AHRQ-funded; HS023641.
Citation: Dugas AF, Kirsch TD, Toerper M .
An electronic emergency triage system to improve patient distribution by critical outcomes.
J Emerg Med 2016 Jun;50(6):910-8. doi: 10.1016/j.jemermed.2016.02.026.
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Keywords: Care Management, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Healthcare Delivery
Stockwell MS, Natarajan K, Ramakrishnan R
Immunization data exchange with electronic health records.
The researchers assessed the impact of exchange of immunization information between an immunization information system (IIS) and an electronic health record on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents. Their findings demonstrated that data exchange can improve child and adolescent immunization status.
AHRQ-funded; HS022667.
Citation: Stockwell MS, Natarajan K, Ramakrishnan R .
Immunization data exchange with electronic health records.
Pediatrics 2016 Jun;137(6). doi: 10.1542/peds.2015-4335.
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Keywords: Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Vaccination
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Lee SJ, Grobe JE, Tiro JA
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
The objective of this study was to characterize the quality of race/ethnicity data collection efforts. The authors assessed race and ethnicity data quality across cancer registries and electronic medical records in two hospitals. Their findings suggested that high-quality race/ethnicity data are attainable. Many of the "errors" in race/ethnicity data were caused by missing or "Unknown" data values.
AHRQ-funded; HS022418.
Citation: Lee SJ, Grobe JE, Tiro JA .
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
J Am Med Inform Assoc 2016 May;23(3):627-34. doi: 10.1093/jamia/ocv156..
Keywords: Cancer, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Racial and Ethnic Minorities, Registries
Bajracharya AS, Crotty BH, Kowaloff HB
Improving health care proxy documentation using a web-based interview through a patient portal.
The authors sought to develop and evaluate a web-based interview to assist patients with health care proxy documentation to be included in the patients' electronic health record. They implemented the interview within the patient portal of an academic health system and analyzed the experience of the first 200 patients to complete it. The patients found the online interview convenient and helpful in establishing a healthcare proxy.
AHRQ-funded; HS021495.
Citation: Bajracharya AS, Crotty BH, Kowaloff HB .
Improving health care proxy documentation using a web-based interview through a patient portal.
J Am Med Inform Assoc 2016 May;23(3):580-7. doi: 10.1093/jamia/ocv133.
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Keywords: Web-Based, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bae J, Encinosa WE
AHRQ Author: Encinosa WE
National estimates of the impact of electronic health records on the workload of primary care physicians.
This study examines whether electronic health records (EHR) is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week. It found that among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size.
AHRQ-authored.
Citation: Bae J, Encinosa WE .
National estimates of the impact of electronic health records on the workload of primary care physicians.
BMC Health Serv Res 2016 May 10;16(1):172. doi: 10.1186/s12913-016-1422-6.
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Keywords: Primary Care, Electronic Health Records (EHRs), Clinician-Patient Communication, Health Information Technology (HIT)
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Taslimitehrani V, Dong G, Pereira NL
Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.
The authors proposed to apply a classification algorithm, Contrast Pattern Aided Logistic Regression (CPXR(Log)) with the probabilistic loss function, to develop and validate prognostic risk models to predict 1, 2, and 5 year survival in heart failure (HF). They found that the new loss function used in the algorithm outperforms other functions used in previous studies and that HF is a highly heterogeneous disease (different subgroups of patients require different types of considerations with their diagnosis and treatment). They concluded that logistic risk models often make systematic prediction errors and that it is prudent to use subgroup based prediction models such as those given by CPXR(Log) when investigating heterogeneous diseases.
AHRQ-funded; HS023077.
Citation: Taslimitehrani V, Dong G, Pereira NL .
Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.
J Biomed Inform 2016 Apr;60:260-9. doi: 10.1016/j.jbi.2016.01.009.
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Keywords: Electronic Health Records (EHRs), Heart Disease and Health, Health Information Technology (HIT), Risk
Plasek JM, Goss FR, Lai KH
Food entries in a large allergy data repository.
This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. It identified 158,552 food allergen records (2,140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3 percent), fruits or vegetables (18.4 percent), dairy (9.0 percent), and peanuts (8.5 percent).
AHRQ-funded; HS022728.
Citation: Plasek JM, Goss FR, Lai KH .
Food entries in a large allergy data repository.
J Am Med Inform Assoc 2016 Apr;23(e1):e79-87. doi: 10.1093/jamia/ocv128.
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Keywords: Data, Health Information Technology (HIT), Electronic Health Records (EHRs), Patient Safety
Cohen GR, Adler-Milstein J
Meaningful use care coordination criteria: perceived barriers and benefits among primary care providers.
This systematic review of studies of laser treatment of infantile hemangioma concluded that the studies primarily addressed different laser modalities compared with observation or other laser modalities. Pulsed dye laser was the most commonly studied laser type, but multiple variations in treatment protocols did not allow for demonstration of superiority of a single method.
AHRQ-funded; HS022674.
Citation: Cohen GR, Adler-Milstein J .
Meaningful use care coordination criteria: perceived barriers and benefits among primary care providers.
J Am Med Inform Assoc 2016 Apr;23(e1):e146-51. doi: 10.1093/jamia/ocv147.
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Keywords: Primary Care, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT)
Singh H, Sittig DF
Measuring and improving patient safety through health information technology: the Health IT Safety Framework.
The authors propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns. A long term framework goal is to enable rigorous measurement that helps achieve the safety benefits of health IT in real-world clinical settings.
AHRQ-funded; HS022087.
Citation: Singh H, Sittig DF .
Measuring and improving patient safety through health information technology: the Health IT Safety Framework.
BMJ Qual Saf 2016 Apr;25(4):226-32. doi: 10.1136/bmjqs-2015-004486.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Health Information Technology (HIT), Patient Safety, Quality Measures