The role of informatics in promoting patient safety

This issue of JAMIA is focused on informatics applications to enhance patient safety. This is one of the most important, yet underemphasized, aspects of the informatics curriculum across the country. Although media attention occasionally concentrates on what can go wrong when information systems are employed in practice, there is also much to say on what might go wrong if information systems were not employed. Additionally, a proper amount of standardization of clinical practices can elevate sub-optimal care to an acceptable level, often reducing cost and patient suffering as a result. Decision support for medication prescribing and dispensing has always been one of the most direct ways for information systems to promote patient safety. Whalen (p. 849) reports on lessons learned in a pediatrics hospital from a transition to a new electronic health record (EHR) system, and Walsh (p. 911) studies the accuracy of the medication list in the EHR and its implications for care, research, and improvement. Cheng (p. 873) shows how using drug knowledgebase information to distinguish between commonly confused drugs can prevent errors, and Vajravelu (p. 780) proposes a new algorithm to analyze multiple pharmacologic exposures using EHR data. Additionally, Samwald (p. 895) shares the experience of implementing pharmacogenomics decision support across seven European countries. The domains in which information systems can improve patient safety are numerous. Waters (p. 901) studies current use, interest, and perceived usability of clinical pathways for primary care, while Sittig (p. 915) describes the levels of adherence to recommended EHR safety practices across eight healthcare organizations. EHRbased intervention and reports on several safety topics are also presented in this issue of JAMIA: Ray (p. 863) uses statistical anomaly detection models for decision support system malfunctions, Chen (p. 790) analyzes interaction patterns of trauma providers that are associated with increased patients’ lengths of stay in the hospital, while Vahdat (p. 827) reports on a simulation study of the effects of EHR implementation on timeliness of care in a dermatology clinic. Berger (p. 833) integrates physical abuse measures into a pediatric clinical decision support system, while Meyer (p. 841) evaluates a mobile application to improve clinical laboratory test ordering. The applications and algorithms described in this issue of JAMIA would be hard to implement without standardization of terminologies, ontologies, and foundational research in natural language processing and information retrieval. Examples of advances in these areas are also featured: Cuzzola (p. 819) links UMLS to DBpedia to promote knowledge discovery, Wang (p. 809) describes efforts involving RxNorm that are leading to a normalized clinical drug knowledge base in China, Vreeman (p. 886) presents a unified terminology for radiology procedures (the “LOINC RSNA Radiology Playbook”), and Blosnich (p. 907) shows how it is possible to use EHR-based clinician text notes to validate transgender-related ICD codes. Additional articles describe approaches that enable a variety of information systems: Mei (p. 800) describes an interactive medical word sense disambiguation method, Kilicoglu (p. 856) reports on the results of automatic recognition of self-acknowledged limitations in the clinical research literature, and Baladron (p. 774) proposes a tool for filtering PubMed search results by sample size. JAMIA continues to publish a combination of application and foundational articles that allows our readers to stay abreast with the best developments in the field. Patient safety is an important topic that has been in the informatics portfolio since its start and for which novel solutions continue to emerge. New topics are also continuously enlarging the informatics portfolio. Stay tuned for the August issue that highlights articles on informatics applications focused on patients, their family and friends, and the expanding scope of our field.