title: Assessing information system readiness for mitigating malpractice risk through simulation: results of a multi-site study.
abstract: OBJECTIVE
  To develop and test an instrument for assessing a healthcare organization's ability to mitigate malpractice risk through clinical decision support (CDS).
  
  
  METHODS
  Based on a previously collected malpractice data set, we identified common types of CDS and the number and cost of malpractice cases that might have been prevented through this CDS. We then designed clinical vignettes and questions that test an organization's CDS capabilities through simulation. Seven healthcare organizations completed the simulation.
  
  
  RESULTS
  All seven organizations successfully completed the self-assessment. The proportion of potentially preventable indemnity loss for which CDS was available ranged from 16.5% to 73.2%.
  
  
  CONCLUSIONS
  There is a wide range in organizational ability to mitigate malpractice risk through CDS, with many organizations' electronic health records only being able to prevent a small portion of malpractice events seen in a real-world dataset.
  
  
  CONCLUSIONS
  The simulation approach to assessing malpractice risk mitigation through CDS was effective. Organizations should consider using malpractice claims experience to facilitate prioritizing CDS development.
authors.affiliation: Partners HealthCare, Boston, MA, USA Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA awright5@partners.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Francine L
authors.initials: FL
authors.lastname: Maloney
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wien
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Lipika
authors.initials: L
authors.lastname: Samal
authors.affiliation: Partners HealthCare, Boston, MA, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Emani
authors.affiliation: Partners HealthCare, Boston, MA, USA Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA CRICO/Risk Management Foundation, Cambridge, MA, USA.
authors.forename: Gianna
authors.initials: G
authors.lastname: Zuccotti
mesh_terms: D003198:Computer Simulation; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D057286:Electronic Health Records; D008318:Malpractice; D012306:Risk; D012984:Software; D014584:User-Computer Interface
keywords: clinical decision support systems; electronic health records; health information technology