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Editorial Introduction

Leslie A. Lenert, Suzanne Bakken
DOI: http://dx.doi.org/10.1197/jamia.M1217 S1 First published online: 1 November 2002

In the past, both health professionals and the public have assumed that the commitment of health professionals to obtaining the best possible outcomes for their patients would guarantee safe and effective health care. Through the work of the Institute of Medicine (IOM) and other leading organizations, however, it has become obvious both to researchers and to society as a whole, that commitment to the betterment of health does not guarantee safe health care practices. As highlighted in “To Err is Human,”1 a shockingly large number of errors occur, despite the best intentions of providers, and many errors have fatal results. Although there is some debate about the exact number of people who die each year as a result of errors,2 by and large, deaths do not occur because of individual negligence—rather they result from flawed systems in which people fail to deliver the quality of a care to which they aspire. How can health professionals perform as they both wish and must? A second IOM report released in 20001, “Crossing the Quality Chasm,”3 identified the critical role that information technology will play in engineering health care systems that produce care that is “safe, effective, patient-centered, timely, efficient, and equitable” (p. 164).

As is well recognized by most readers of JAMIA, the needed information technologies are not yet readily available or easily implementable.

Improving safety through information technology is an inherently cross-disciplinary effort that requires close collaboration among computer scientists, engineers, and social scientists for a successful endeavor. Where could such a diverse group of people come together to present work and advance this nascent field?

This special issue presents papers, posters, and panel discussions from the 2001 AMIA Fall Symposium addressing the issues of patient safety. Three additional papers provide guidance for integrating patient safety concepts into continuing medical education, undergraduate medical education, and nursing informatics curricula. This meeting was one of the first major scientific meetings devoted to medical computing after the new funding initiatives to develop specific research support for the safety area. Papers were part of the first-ever meeting track devoted to the issue of patient safety. These results represent the new wine—first fruits of researchers coming to the safety arena as a result of national initiatives—as well as the continuing contributions of stalwarts in the field. As is typical of Fall Symposium meetings, the papers in this supplement present conceptual models, technological developments that are evolving and still being evaluated, and a snapshot of ongoing research related to computer safety systems.

The breadth of work highlighted in this issue reveals that the pursuit of safer practices requires a multifaceted approach. Work presented in the track included work on clinical systems, human factors, knowledge representation, and protecting confidentiality. As of result of the 9-11 terrorist attacks, we have expanded the focus of safety work presented in this issue to include work related to detection of bioterrorist incidents and other issues relevant to homeland security.

It is our hope that this issue provides clinicians and educators with a glimpse into the future of the role of technology in improvement of safety and quality of care. As efforts continue to expand funding for use of informatics to enhance safety, we hope that this issue also provides important feedback to policy makers about the types of programs ongoing in the research community and the needs of that community for research support.