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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/36370/psn-pdf
    June 12, 2013 - Health Information Technology in the United States: The Information Base for Progress. June 12, 2013 Blumenthal D, DesRoches C, Donelan K, et al. Princeton, NJ: Robert Wood Johnson Foundation; 2006. https://psnet.ahrq.gov/issue/health-information-technology-united-states-information-base-progress This report share…
  2. psnet.ahrq.gov/issue/informal-learning-error-hospitals-what-do-we-learn-how-do-we-learn-and-how-can-informal
    March 14, 2012 - Review Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review. Citation Text: de Feijter JM, de Grave WS, Koopmans RP, et al. Informal learning from error in hospitals: what do we learn, how do we learn…
  3. psnet.ahrq.gov/issue/automated-identification-extreme-risk-events-clinical-incident-reports
    November 03, 2015 - Study Automated identification of extreme-risk events in clinical incident reports. Citation Text: Ong M-S, Magrabi F, Coiera E. Automated identification of extreme-risk events in clinical incident reports. J Am Med Inform Assoc. 2012;19(e1):e110-8. Copy Citation Format: Go…
  4. psnet.ahrq.gov/issue/challenges-ethics-safety-best-practices-and-oversight-regarding-hit-vendors-their-customers
    July 30, 2014 - Commentary Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force. Citation Text: Goodman KW, Berner ES, Dente MA, et al. Challenges in ethics, safety, best practices, and oversight regard…
  5. psnet.ahrq.gov/issue/improving-end-life-care-information-systems-approach-reducing-medical-errors
    November 04, 2015 - Study Improving end of life care: an information systems approach to reducing medical errors. Citation Text: Tamang S, Kopec D, Shagas G, et al. Improving end of life care: an information systems approach to reducing medical errors. Stud Health Technol Inform. 2005;114:93-104. Copy C…
  6. psnet.ahrq.gov/issue/role-personal-health-information-management-promoting-patient-safety-home-qualitative
    June 15, 2022 - Study The role of personal health information management in promoting patient safety in the home: a qualitative analysis Citation Text: Demiris G, Lin S-Y, Turner AM. The role of personal health information management in promoting patient safety in the home: a qualitative analysis. Stud …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/45057/psn-pdf
    June 22, 2017 - Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England. June 22, 2017 Cresswell K, Mozaffar H, Lee L, et al. Safety risks associated with the lack of integration and interfacing of …
  8. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/852273/psn-pdf
    August 09, 2023 - Experimental evidence for structured information-sharing networks reducing medical errors. August 9, 2023 Centola D, Becker J, Zhang J, et al. Experimental evidence for structured information–sharing networks reducing medical errors. Proc Natl Acad Sci U S A. 2023;120(31):e2108290120. doi:10.1073/pnas.2108290120. …
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/44672/psn-pdf
    October 11, 2017 - Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports. October 11, 2017 Magrabi F, Liaw ST, Arachi D, et al. Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports. BMJ…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47195/psn-pdf
    September 12, 2018 - Diagnostic discordance, health information exchange, and inter-hospital transfer outcomes: a population study. September 12, 2018 Usher M, Sahni N, Herrigel D, et al. Diagnostic discordance, health information exchange, and inter- hospital transfer outcomes: a population study. J Gen Intern Med. 2018;33(9):1447-145…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73440/psn-pdf
    June 30, 2021 - Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes. June 30, 2021 Cifra CL, Sittig DF, Singh H. Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients’ subsequent clinical course and outcomes. BMJ Qual …
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/38309/psn-pdf
    December 23, 2016 - Safely implementing health information and converging technologies. December 23, 2016 Safely implementing health information and converging technologies. Sentinel event alert. 2008;(42):1-4. https://psnet.ahrq.gov/issue/safely-implementing-health-information-and-converging-technologies As health information techno…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/47349/psn-pdf
    January 30, 2019 - Relationship of staff information sharing and advice networks to patient safety outcomes. January 30, 2019 Brewer BB, Carley KM, Benham-Hutchins MM, et al. Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes. J Nurs Adm. 2018;48(9):437-444. doi:10.1097/NNA.0000000000000646. ht…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/72817/psn-pdf
    March 10, 2021 - Assessment of patients' ability to review electronic health record information to identify potential errors: cross- sectional web-based survey. March 10, 2021 Freise L, Neves AL, Flott K, et al. Assessment of patients' ability to review electronic health record information to identify potential errors: cross-secti…
  15. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/34879/psn-pdf
    February 03, 2011 - Missing clinical information during primary care visits. February 3, 2011 Smith PC, Araya-Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. JAMA. 2005;293(5):565-71. https://psnet.ahrq.gov/issue/missing-clinical-information-during-primary-care-visits This survey of 253 primary ca…
  16. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.185_slideshow.ppt
    October 01, 2008 - Spotlight Case July 2008 Spotlight Case Recurrent Hypoglycemia: A Care Transition Failure? * * Source and Credits This presentation is based on the October 2008 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Ted Eytan, MD, MS, MPH Editor, …
  17. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42213/psn-pdf
    April 17, 2013 - Quality: performance improvement, teamwork, information technology and protocols. April 17, 2013 Coleman NE, Pon S. Quality: performance improvement, teamwork, information technology and protocols. Crit Care Clin. 2013;29(2):129-51. doi:10.1016/j.ccc.2012.11.002. https://psnet.ahrq.gov/issue/quality-performance-im…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/42501/psn-pdf
    January 07, 2015 - Syndromic surveillance for health information system failures: a feasibility study. January 7, 2015 Ong M-S, Magrabi F, Coiera E. Syndromic surveillance for health information system failures: a feasibility study. J Am Med Inform Assoc. 2013;20(3):506-12. doi:10.1136/amiajnl-2012-001144. https://psnet.ahrq.gov/iss…
  19. psnet.ahrq.gov/web-mm/falling-between-cracks-software
    March 09, 2011 - Falling Between the Cracks in the Software Citation Text: Adler-Milstein J. Falling Between the Cracks in the Software. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2016. Copy Citation Format: Google Scholar BibTeX En…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49614/psn-pdf
    November 01, 2010 - Reconciling Records November 1, 2010 Singh H, Sittig DF, Layden M. Reconciling Records. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/reconciling-records The Cases   Case 1. A patient receiving care at a Veterans Affairs (VA) outpatient clinic was admitted to a local teaching hospital. When discharged, h…

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