eHealth for patient safety:
towards a European research roadmap
Veli N. Stroetmann*, Daniel Spichtinger*, Karl A. Stroetmann*, Jean Pierre Thierry‡
*empirica Communication and Technology Research, Bonn, Germany
‡Symbion, Maisons-Laffitte, France
Correspondence: Dr. Veli N. Stroetmann, empirica, Oxfordstr. 2, D-53111 Bonn,
Germany; Email: veli (dot) stroetmann (at) empirica (dot) com
Summary: This paper analyses key issues towards a research roadmap for eHealth-
supported patient safety. The raison d’etre for research in this area is the high number
of adverse patient events and deaths that could be avoided if better safety and risk
management mechanisms were in place. The benefits that ICT applications can bring
for increased patient safety are briefly reviewed, complemented by an analysis of key
ICT tools in this domain. The paper outlines the impact of decision support tools,
CPOE, as well as incident reporting systems.
Some key research trends and foci like data mining, ontologies, modelling and
simulation, virtual clinical trials, risk models, health pathways, bar codes and RFID,
preparedness for large-scale events are touched upon.
Finally, the synthesis points to the fact that only a multilevel analysis of ICT in patient
safety will be able to address this complex issue adequately. The eHealth for Safety
study will give insights into the structure of such an analysis in its lifetime and arrive at
a vision and roadmap for more detailed research on increasing patient safety through
ICT.
Healthcare as a risky endeavour
Reflecting on more than a decade of global research, two, by now famous, USA Institute of Medicine
(IOM) reports, To Err Is Human1 (2000) and Crossing the Quality Chasm2 (2001) highlighted the risks of
modern healthcare. The first report included an estimate that organisational systems failures in
healthcare delivery (i.e., poorly designed or “broken” care processes) were responsible for at least
90,000 deaths each year in the USA. The second report revealed a wide “chasm” between the quality of
care the health system should be capable of delivering today (given the astounding advances in medical
science and technology in the past half century) and the quality of care most Americans received. In its
recent report Ending the Document Game: Connecting and Transforming Your Healthcare Through
Information Technology3 the US Commission on Systemic Interoperability pointed out that medical
errors are killing more people each year than breast cancer, AIDS, or motor vehicle accidents.4
It is widely believed that the situation in many, if not all European health delivery contexts is
characterised by similar, if not the same deficiencies. Of activities seen as potentially risky, travel by rail
in Europe or commercial air travel are actually among the safest activities, with fewer than one in
100,000 fatalities per personal encounter or trip. Driving is far more dangerous as Figure 1 shows. It is
no surprise that statistically, mountain climbing and bungee jumping are among the most dangerous

1 IOM Report (2000). To err is human: Building a safer health system. Institute of Medicine, 287 p. Available at:
http://books.nap.edu/books/0309068371/html/index.html.
2 IOM Report (2001). Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality of Health
Care in America, Institute of Medicine, 364 p., http://books.nap.edu/catalog/10027.html
3 Commission on Systemic Interoperability (2005): Ending the Document Game: Connecting and Transforming Your Healthcare
Through Information Technology, U.S. Government Printing Office (GPO), Washington, October 2005, 249 p.,
http://endingthedocumentgame.gov/PDFs/entireReport.pdf
4 Institute of Medicine, Centers for Disease Control and Prevention; National Center for Health Statistics: Preliminary Data for
1998 and 1999, 2000.

activities. But a great surprise is that there are more deaths per encounter with the healthcare system
than for any of these other activities.5

FIGURE 1: RISK OF FATALITY IN DIFFERENT DOMAINS

Source: AHRQ, Commission on Systemic Interoperability, USA, 2005
ICT in healthcare: current state of play
The benefits that information and communications technologies (ICT) can bring for improved quality of
care and increased patient safety are briefly reviewed in this section, complemented by a short analysis
of the state of play in the implementation of some key ICT tools.
ICT applications can be useful in almost every aspect of healthcare, including the delivery of care to
remote locations, reducing costs, increasing the efficiency of delivery, facilitating information and
communication within and among healthcare organisations, simplifying diagnostic and therapeutic
processes and, last but most important, increasing the quality of care provided to patient, including
improvements in patient safety.6 ICTs are expected to help relieve the strain that healthcare systems
experience: the pressure to increase the quality of care and decrease costs simultaneously.7 The recent
IOM/NAE report8, Building a Better Delivery System: A New Engineering/Health Care Partnership
underscores the importance of information and communications technologies for meeting
multidimensional performance challenges. It also identified proven, fundamental engineering concepts,
such as designing for safety, mass customisation, continuous flow, and production planning, that could
be brought to bear immediately to redesign and improve care processes to facilitate risk management,
deliver greater patient safety and better quality.
Furthermore, Wachter9 indicates that “it seems self-evident that many, perhaps most, of the solutions to
medical mistakes will ultimately come through better information technology. We may finally be nearing
the time when institutions and providers will not be seen as credible providers of safe, high-quality care

5 Scott Young. The Role of Health IT in Reducing Medical Errors and Improving Healthcare Quality & Patient Safety. Agency for
Healthcare Research and Quality. August 2005. http://www.ehealthinitiative.org/assets/documents/Capitol_Hill_Briefings/Young9-
22-04.PPT
6 JRC/IPTS (2004) eHealth in the Context of a European Ageing Society. A Prospective Study. P.17.
7 European Commission: The Social Situation in the European Union 2003. Luxembourg: Office for Official Publications. P. 69.
8 Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors, (2005): Building a Better Delivery System:
A New Engineering/Health Care Partnership. Committee on Engineering and the Health Care System, National Academies Press,
276 p., http://www.nap.edu/catalog/11378.html
9 Wachter, R (2004) The End Of The Beginning: Patient Safety Five Years After ‘To Err Is Human’. Health Affairs Web Exclusive.
W4- 539.