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Appendix B
Literature Review Methods
The committee reviewed the published literature to identify what is
known about the relationship between patient safety and health information
technology (health IT)–assisted care. In the preliminary analysis, the literature
was searched, reviewed, analyzed, sorted into categories (see category defini-
tions below), and summarized into a table. “Health IT–assisted care” means
health care and services that incorporate and take advantage of health IT and
health information exchanges for the purpose of improving the processes
and outcomes of health care services. Health IT–assisted care includes care
supported by and involving electronic health records (EHRs), clinical decision
support, computerized provider order entry, health information exchange,
patient engagement technologies, and other health information technologies
used in clinical care.
SEARCH STRATEGY
Extensive search terms were used in four databases—Medline, EMBase,
Web of Science, and Cochrane—yielding initial results of 2,868 articles,
books, and other literature. A search strategy was developed for each data-
base using terms and Medical Subject Headings focused in subject areas
related to patient safety, medical informatics, and other related areas.1
1 Subject areas included quality of health care (accidental harm, adverse events, diagnostic
errors, errors of omission or commission, injuries, medication errors, safety, and treatment
outcomes) and medical informatics (human factors, informatics, system design, systems analy-
sis, usability, and user–computer interface).
181
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182 HEALTH IT AND PATIENT SAFETY
Strategy parameters included limiting the search to human subjects, the
English language, and results published between January 2005 and Novem-
ber 2010 because the literature regarding health IT evolves rapidly and
continually builds upon itself. Next, hand searches through the references
were conducted and relevant studies were included. Primary and secondary
research (e.g., meta-analyses, controlled trials) suggested by the public and
the committee were also added to the search results. Other literature (e.g.,
editorials, commentaries) were excluded from the search results.
CATEGORIZATION AND ANALYSIS
Titles and abstracts of the articles produced from the search were
rigorously reviewed to determine which studies met the inclusion criteria
for study quality and relevance. Pairs of reviewers evaluated titles and ab-
stracts of all studies within each subject area. Each reviewer independently
assigned articles to one of three categories with Category 1 being the most
relevant and Category 3 being the least relevant (see definitions below).
Category 1: Literature examining how health IT affects patient safety.
1a. Systematic reviews2
1b. Experimental studies
1c. Observational studies
Category 2: Literature describing efforts to improve quality of health
care through implementation of one or more of the following com-
ponents of health IT (e.g., system design, systems analysis, usability,
user–computer interface, or human factors).
Category 3: Studies not related to patient safety and health IT.
Reviewers then compared their evaluations, and any disagreement was
resolved through discussion. The full texts of articles determined to be
Category 1 were retrieved, evaluated, and, if needed, recategorized.
2 A systematic review is defined as a scientific investigation that focuses on a specific ques-
tion and that uses explicit, preplanned scientific methods to identify, select, assess, and sum-
marize the findings of similar but separate studies. It may or may not include a quantitative
synthesis of the results from separate studies (meta-analysis).
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183
APPENDIX B
RESULTS
The search yielded 128 Category 1 articles. These articles were then
placed in two tables—one table summarizing each of the systematic reviews
(Table B-1)3 and the other table summarizing each of the experimental and
observational studies (Table B-2).4 Within the table, the articles were then
organized by the type of health IT component.5
An additional 479 articles were identified as Category 2, which inform
broader parameters of patient safety and health IT. These parameters in-
clude efforts to improve quality of health care through the implementation
of one or more of the following: system design, systems analysis, usability,
user–computer interface, or human factors.
The remaining studies were classified as Category 3 studies, which
did not meet the inclusion criteria and were not broadly considered in the
literature review or table.
Although Category 1 articles published before January 2005 and Cat-
egory 2 articles were not included in the literature review table, these
articles were used throughout the committee’s deliberations as background.
Additionally, articles that were not studies or reviews of studies, such as
editorials and commentaries, were not included in the literature table but
were still considered and used in the analysis of the report.
3 Table B-1 is included on CD in the back of the book and online at: http://www.nap.edu/
html/13269/app_b_tables.pdf.
4 Table B-2 is included on CD in the back of the book and online at: http://www.nap.edu/
html/13269/app_b_tables.pdf.
5 The majority of the studies focused on how individual components of health IT affect
patient safety (e.g., alerts, bar-coding, clinical decision support, EHRs, electronic prescrib-
ing, patient engagement tools, smartpumps, surveillance tools, and other health IT–assisted
care). Therefore, the tables were organized by the components that each article was studying.
Articles not focusing on a specific component were placed at the beginning of each table and
are labeled as “overview” articles.
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