TY - JOUR T1 - The health information technology safety framework: building great structures on vast voids JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 218 LP - 220 DO - 10.1136/bmjqs-2015-004746 VL - 25 IS - 4 AU - Ross Koppel Y1 - 2016/04/01 UR - http://qualitysafety.bmj.com/content/25/4/218.abstract N2 - With their health information technology (HIT) safety framework, Drs Hardeep Singh and Dean Sittig offer many admirable suggestions to improve the safety of computerised provider order entry and electronic health records (EHRs).1 As I shall try to explain, however, I find their proposed framework less than the sum of its parts because: (1) some of its parts, in my opinion, are misdirected; (2) they make errors in their assumptions about what we can know about errors and HIT and (3) their key recommendations lack regulatory or legal teeth. Despite the authors’ fine intentions and several excellent insights and recommendations, I fear their proposal will function more as a distraction than as a useful plan for improving HIT safety—something to make us feel useful while we do not address the underlying problems.Acknowledging that we often do not know about the errors associated with the use of HIT, the authors write: ‘…[C]ausal attributions for health IT-related risks and adverse events are also difficult to identify, as they generally involve interactions of technical and non-technical factors which are notoriously difficult to separate’. (As discussed below, however, the authors often ignore this insight.)They wisely call for us to ‘develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety’.They thoughtfully point out that previous efforts are ‘notable [for the fact] that none of these data [on errors] have been collected from vendors’.They recommend needed steps when they write that we must: (1) refine the science of measuring health IT-related patient safety; (2) make health IT-related patient safety an organisational priority by securing commitment from organisational leadership and refocusing the organisation's clinical governance structure to facilitate measurement and monitoring and (3) develop an environment that is conducive to detecting, fixing and learning from system … ER -