maintain. This report explains the potential benefits and risks of health IT and asks for greater transparency, accountability, and reporting.

In this report, health IT includes a broad range of products, including EHRs,3 patient engagement tools (e.g., personal health records [PHRs] and secure patient portals), and health information exchanges; excluded is software for medical devices. Clinicians expect health IT to support delivery of high-quality care in several ways, including storing comprehensive health data, providing clinical decision support, facilitating communication, and reducing medical errors. Health IT is not a single product; it encompasses a technical system of computers and software that operates in the context of a larger sociotechnical system—a collection of hardware and software working in concert within an organization that includes people, processes, and technology.

It is widely believed that health IT, when designed, implemented, and used appropriately, can be a positive enabler to transform the way care is delivered. Designed and applied inappropriately, health IT can add an additional layer of complexity to the already complex delivery of health care, which can lead to unintended adverse consequences, for example dosing errors, failure to detect fatal illnesses, and delayed treatment due to poor human-computer interactions or loss of data.

In recognition of the rapid adoption of health IT, the Office of the National Coordinator for Health Information Technology (ONC) asked the IOM to establish a committee to explore how private and public actors can maximize the safety of health IT-assisted care. The committee interpreted its charge as making health IT-assisted care safer so the nation is in a better position to realize the potential benefits of health IT.

EVALUATING THE CURRENT STATE OF PATIENT SAFETY AND HEALTH IT

The expectations for safer care may be higher in a health IT-enabled environment as compared to a paper-based environment because the opportunity to improve patient care is much greater. The evidence in the literature about the impact of health IT on patient safety, as opposed to quality, is mixed but shows that the challenges facing safer health care and safer use of health IT involve the people and clinical implementation as much as the technology. The literature describes significant improvements in some aspects of care in health care institutions with mature health IT. For example, the use of computerized prescribing and bar-coding systems has been shown

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3 “Electronic health records” is used as the desired term because it is more inclusive of the way electronic records are being used currently than “electronic medical records.” EHRs include clinical decision support tools, computerized provider order entry systems, and e-prescribing systems.



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