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May 19, 2010

Monitoring and Evaluating the Use of Electronic Health Records—Reply

JAMA. 2010;303(19):1918-1919. doi:10.1001/jama.2010.591

In Reply: We share Dr Koppel's concern regarding challenges of detecting noncatastrophic errors that might result from inadequate EHR design, development, implementation, and use. We agree that the voluntary national reporting structure we advocate will cover only a small fraction of actual errors and likely miss errors that are minor and never lead to an adverse event.

It was our intent that these types of errors would be addressed through the enhanced EHR certification approaches we recommended. Our recommendation for investigation by a national EHR adverse event investigation board, similar to the National Transportation Safety Board or the Commercial Aviation Safety Team, applies only to extremely serious EHR-related events resulting from problems in 1 or more of the 8 dimensions of safe EHR use.1 The severity of these events should be akin to those identified as reviewable sentinel events by the Joint Commission (eg, unanticipated death of a full-term infant, discharge of an infant to the wrong family, hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities, surgery on the wrong patient or wrong body part, or unintended retention of a foreign object in a patient after surgery or other procedure).