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Quality & safety in the literature: May 2021
  1. Juan J Gonzalez1,
  2. Nathan Houchens1,2,
  3. Ashwin Gupta1,2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  1. Correspondence to Juan J Gonzalez, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA; juanjgon{at}

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Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies recently published in major medical journals. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • Clinicians in the United States (US) spend more time actively using electronic health records (EHRs), receive more system-generated messages, write a higher proportion of automatically generated note text and spend more time using the EHR after working hours, compared with non-US clinicians. JAMA Int Med, 14 December 2020

  • US clinicians prescribe a significantly larger quantity of opioid medications on postoperative discharge and display a greater variation in opioid prescribing patterns compared with the rest of the world. Annals of Surgery, December 2020

  • A machine learning model showed accurate discriminative capabilities for the prediction of 1-year all-cause death, myocardial infarction and major bleeding after an acute coronary syndrome event. Further studies are needed to compare with current tools and assess clinical utility. Lancet, 16 January 2021

Assessment of electronic health record use between US and non-US health systems

JAMA Int Med, 14 December 2020

Most United States (US) clinicians1 and many of those around the world have adopted electronic health records (EHRs), with data showing a steady growth of national EHR adoption in the last 15 years and a 46% global increase in the past 5 years.2 EHR use may improve medical outcomes,3 4 communication5 and costs6 7 but also has been proven to be a source of clinician inefficiency and fatigue.8 9 EHRs add to after-hours work,10 11 disrupt the clinician–patient relationship11–13 and contribute to clinician job dissatisfaction and burnout,14 15 which can lead to higher rates of medical error.16 17 …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.