Intended for healthcare professionals


When hospitals switch to electronic records

BMJ 2016; 354 doi: (Published 28 July 2016) Cite this as: BMJ 2016;354:i3941
  1. Robert L Wears, research professor1 2
  1. 1Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
  2. 2Clinical Safety Research Unit, Imperial College London, London, UK
  1. wears{at}

If nothing goes wrong, is everything all right?

In a linked paper, Barnett and colleagues (doi:10.1136/bmj.i3835) studied the consequences of one of the most disruptive events a hospital can experience, short of mass casualty incidents or natural disasters—implementing a new electronic health record (EHR) system.1 Reports of unintended consequences2 and patient harms3 from these events have raised understandable concerns about how well we manage them. The investigators addressed these concerns by estimating changes in a set of outcome measures at several months before and after implementation of a new EHR in 17 US hospitals; they then compared those changes with changes in the same measures in 399 control hospitals over the same regions and dates. They included only “big bang” implementations, in which all clinical functions transition to the new system on a single “go live” date; these are likely more disruptive than gradual roll-outs. The primary outcomes were changes in 30 day mortality and readmissions; …

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