Measuring and improving patient safety through health information technology: The Health IT Safety Framework

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This is a review of Hardeep Singh and Dean Sittig's "Measuring and improving patient safety through health information technology: The Health IT Safety Framework." [1]


Despite rapid adoption and use of health information technology (HIT or health IT) with the potential to improve patient safety outcomes, there is still no clear way to measure the impact of this technology on these outcomes. The health IT safety framework was created to contextualize "health IT-related patient safety measurement, monitoring, and improvement." [1]

Framework Rationale

Most organizations have not been focusing on health IT-related patient safety as they race to implement systems that meet meaningful use (MU) criteria. This framework will help put measurement of health IT-related patient safety at the forefront of an organization's existing patient safety efforts, which will be essential as use of HIT continues to flourish. The 3 essential elements this framework addresses are:

"1. refine the science of measuring health IT-related patient safety 2. make health IT-related patient safety an organizational priority by securing commitment from organizational leadership and refocusing the organization's clinical governance structure to facilitate measurement and monitoring 3. develop an environment that is conducive to detecting, fixing and learning from system vulnerabilities." [1]

Overview of Framework

Follows principles of "continuous quality improvement."

Sociotechnical Work System

Sociotechnical systems are comprised of 8 components:

  • Hardware and software
  • Clinical content
  • Human-Computer interface
  • People
  • Workflow and communication
  • Internal organizational features
  • External rules and regulations
  • Measurement and monitoring

The HITS Framework presupposes that patient safety events must be considered in the context of these 8 sociotechnical domains.

Measurement of three overlapping domains of HITS

In addition to the sociotechnical system, there are 3 domains of health IT implementation and use:

  • Safe health IT
  • Safe use of health IT
  • Using health IT to improve safety

Measurement must occur in all 3 domains, both retrospectively and proactively in order to learn from past events and prevent those that could occur in the future.

Measures should be impactful, scientifically acceptable, feasible, usable, and transparent.

Expected Measurement Impact

Diverse stakeholders must come together to improve measurement of safety concerns related to or able to be determined via effective use of health IT. Organizations must continue to learn from the data these measures generate and must take a "360-degree approach" to analyzing and reacting to said data. If an organization prioritizes these efforts, they will develop a culture of health IT-related patient safety and will be able to learn how to improve safety of their HIT systems.

Use of the Framework to Overcome Challenges of Real-World Measurement

The framework's components can work together to advance measurement of HIT-related safety.

Uncover hidden HIT safety risks

Health care organizations need to be aware of the potential existence of "hidden" safety risks related to HIT. Proper measurement and analysis can help expose such concerns, and in order to address them, organizations should consider bringing in multidisciplinary teams of professionals with experience in these sorts of issues, such as informaticists or human factors engineers.

Facilitate organizational preparedness

Prior to implementing these measurements, organizations need to assess their current state of HIT safety and understand how this is integrated with their patient safety paradigm. There are tools to help organizations assess risk, such as the ONC sponsored SAFER guides (ONC Issues Guides for SAFER EHRs).

Advance Current Measurement Methods

Current measurement methods for IT-related (and other patient safety) errors are mostly based on self-report, which is inadequate to determine true frequencies of such errors. Health care organizations will need to use alternative methods to collect data, analyze it, and then respond to these errors.

Some potential methods of measurement moving forward are:

  • use of electronic trigger algorithms
  • helpdesk logs
  • provocative testing
  • real-time observations
  • feedback from users

Identify top priorities for measure development

The framework's potential supersedes health care organizations and can also be used to prioritize policy development with regard to safety of HIT.


This all-encompassing framework will help health care organizations and policy-making organizations alike conceptualize patient safety as it relates to health IT, enabling the prioritization and development of measurement tools and systems to improve patient safety and safe use of health IT.


This article throws into sharp relief just how little we have advanced the use of health IT since its inception. It also provides a very thorough context and explanation for why health care organizations and the nation as a whole must strive to improve our ability to collect large sums of useful data from these systems and then learn from and act on it continuously in order to affect true system improvement. Unfortunately, I think most health care organizations are a long way off from considering their health IT safety in the context of a model such as this, but it is important that policymakers move towards this sort of framework so that the rest of the country follows suit.

Related Resources

Related frameworks: Electronic health records and national patient-safety goals and A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems


  1. 1.0 1.1 1.2 Hardeep Singh and Dean F. Sittig. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Qual Saf. Published online first 2015 September.