Iatrogenic Harm
Chapter 6 Bedside Questions · 10 questions · about 10 minutes
Health IT safety Domain II, using health IT safely, has no owner in most health systems, so recurring, preventable technology-related harms (alert fatigue, wrong patient, workflow mismatch, missed results, algorithmic error, physician pacification) persist unrecognized as one syndrome and are counted only after events occur.
Iatrogenic disease: health IT, like aspirin, HRT or opioids, is a powerful therapy that harms patients when misconfigured, and the standard of care is to change the prescription rather than keep refilling it.
Answer as your executive team would, with the evidence in hand. Each question has a factual answer in a system you already own.
Which of the three health IT safety domains do you actively measure, and can you name all three?
Add a note: where is the evidence, or who owns it?
Has every reportable safety event in the last 12 months been examined for an informatics root cause?
Add a note: where is the evidence, or who owns it?
What is your alert override rate and its trend?
Add a note: where is the evidence, or who owns it?
Have you implemented a patient-verification forcing function at order entry?
Add a note: where is the evidence, or who owns it?
Is closed-loop critical-result management documented, audited and owned by a named person?
Add a note: where is the evidence, or who owns it?
Have you completed a SAFER Guides self-assessment? When, and what happened to the findings?
Add a note: where is the evidence, or who owns it?
Are AI deployments locally validated with subgroup performance monitored over time?
Add a note: where is the evidence, or who owns it?
Are value-based payment adjustments improving year over year? If not, why?
Add a note: where is the evidence, or who owns it?
When information fails to reach the person who needed it, is it recorded as a communication failure or a clinical one?
Add a note: where is the evidence, or who owns it?
Who in the C-suite is accountable for iatrogenic technology harm as a category?
Add a note: where is the evidence, or who owns it?
A reflection tool from the book, not a validated diagnostic test or benchmark. Your answers and notes stay in this browser unless you choose to send them. Please don't enter patient information.
When the prescription is hurting the patient, the standard of care is to change the prescription. In healthcare, we keep refilling it.
The Diagnostician, Chapter 6