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Research has indicated that health information technology has the potential to reduce medical error and the chances of an adverse event occurring. However, research has indicated that poorly designed systems may inadvertently lead to error (technology-induced error). In this paper, we describe our most recent work in developing a new framework for the integration of multiple forms of simulation to ensure that systems are safe by predicting and preventing technology-induced error in healthcare. The approach taken involves the integration of "clinical simulations" with computer-based simulations. In a case study, the combination of clinical simulations (i.e., involving video analysis of health professionals interacting with computerized physician order entry) and the use of computer modelling and simulation tools is described. In our work, we first employ clinical simulation to obtain baseline error rates. Next, we input data from the clinical simulations into a computer-based simulation and modelling tool to assess the impact of specific aspects of system and interface design upon error rates. The practical implications of combining the advantages of clinical simulation with "in the box" computer-based simulation to predict the impact of healthcare information systems (HIS) are discussed. Implications of this work for healthcare institutions and policy decision-making are explored.

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Toward an Integrated Simulation Approach for Predicting and Preventing Technology-Induced Errors in Healthcare: Implications for Healthcare Decision-Makers