title: Challenges in patient safety improvement research in the era of electronic health records.
abstract: Electronic health record (EHR) data repositories contain large volumes of aggregated, longitudinal clinical data that could allow patient safety researchers to identify important safety issues and conduct comprehensive evaluations of health care delivery outcomes. However, few health systems have successfully converted this abundance of data into useful information or knowledge for safety improvement. In this paper, we use a case study involving a project on missed/delayed follow-up of test results to discuss real-world challenges in using EHR data for patient safety research. We identify three types of challenges that pose as barriers to advance patient safety improvement research: 1) gaining approval to access/review EHR data; 2) interpreting EHR data; 3) working with local IT/EHR personnel. We discuss the complexity of these challenges, all of which are unlikely to be unique to this project, and outline some key next steps that must be taken to support research that uses EHR data to improve safety. We recognize that all organizations face competing priorities between clinical operations and research. However, to leverage EHRs and their abundant data for patient safety improvement research, many current data access and security policies and procedures must be rewritten and standardized across health care organizations. These efforts are essential to help make EHRs and EHR data useful for progress in our journey to safer health care.
authors.affiliation: Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Elise
authors.initials: E
authors.lastname: Russo
authors.affiliation: University of Texas Health Science Center at Houston's School of Biomedical Informatics and the UT-Memorial Hermann Center for Healthcare Quality & Safety, Houston, TX, United States.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Murphy
authors.affiliation: Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States. Electronic address: hardeeps@bcm.edu.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D057210:Delayed Diagnosis; D057286:Electronic Health Records; D006302:Health Services Research; D006801:Humans; D008490:Medical Informatics; D061214:Patient Safety; D036301:Qualitative Research; D058996:Quality Improvement