{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:57:31Z","timestamp":1776920251922,"version":"3.51.2"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T00:00:00Z","timestamp":1524441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy034","type":"journal-article","created":{"date-parts":[[2018,3,17]],"date-time":"2018-03-17T12:07:20Z","timestamp":1521288440000},"page":"848-854","source":"Crossref","is-referenced-by-count":40,"title":["Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system"],"prefix":"10.1093","volume":"25","author":[{"given":"Kimberly","family":"Whalen","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]},{"given":"Emily","family":"Lynch","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]},{"given":"Iman","family":"Moawad","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]},{"given":"Tanya","family":"John","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]},{"given":"Denise","family":"Lozowski","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]},{"given":"Brian M","family":"Cummings","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, MA, USA"}]}],"member":"286","published-online":{"date-parts":[[2018,4,23]]},"reference":[{"issue":"1","key":"2020110612390954000_ocy034-B1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1093\/eurpub\/ckv122","article-title":"The impact of electronic health records on healthcare quality: a systematic review and meta-analysis","volume":"26","author":"Campanella","year":"2015","journal-title":"Eur J Public Health"},{"issue":"1","key":"2020110612390954000_ocy034-B2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1108\/14664100110384948","article-title":"The role of information technology in enhancing patient satisfaction","volume":"6","author":"Zabada","year":"2001","journal-title":"Brit J Clin Governance"},{"issue":"1","key":"2020110612390954000_ocy034-B3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s10729-011-9179-2","article-title":"US hospital efficiency and adoption of health information technology","volume":"15","author":"Zhivan","year":"2012","journal-title":"Health Care Manag Sci"},{"issue":"3","key":"2020110612390954000_ocy034-B4","doi-asserted-by":"crossref","first-page":"e756","DOI":"10.1542\/peds.2014-4148","article-title":"Council on Clinical Information Technology. 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The Road Ahead","volume":"304","author":"Jha","year":"2010","journal-title":"JAMA"},{"key":"2020110612390954000_ocy034-B9","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJMp1006114","article-title":"The \u201cMeaningful Use\u201d regulation for electronic health records","volume":"363","author":"Blumenthal","year":"2010","journal-title":"N Engl J Med"},{"key":"2020110612390954000_ocy034-B10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1741-7015-9-46","article-title":"Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review","volume":"9","author":"McGinn","year":"2011","journal-title":"BMC Med"},{"issue":"11","key":"2020110612390954000_ocy034-B11","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.ijmedinf.2014.06.011","article-title":"Electronic health records implementation: an evaluation of information system impact and contingency factors","volume":"83","author":"Nguyen","year":"2014","journal-title":"Int J Med Inform"},{"issue":"5","key":"2020110612390954000_ocy034-B12","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1016\/j.ijmedinf.2012.10.007","article-title":"Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review","volume":"82","author":"Cresswell","year":"2013","journal-title":"Int J Med Inform"},{"key":"2020110612390954000_ocy034-B13","doi-asserted-by":"crossref","first-page":"i3835","DOI":"10.1136\/bmj.i3835","article-title":"Adverse inpatient outcomes during the transition to a new electronic health record system: observational study","volume":"354","author":"Barnett","year":"2016","journal-title":"BMJ"},{"key":"2020110612390954000_ocy034-B14"},{"key":"2020110612390954000_ocy034-B15"},{"issue":"4","key":"2020110612390954000_ocy034-B16","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.4338\/ACI-2016-06-R-0105","article-title":"Mind the Gap","volume":"7","author":"Ratwani","year":"2016","journal-title":"Appl ClinI Inform"},{"issue":"3","key":"2020110612390954000_ocy034-B17","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1093\/jamia\/ocu001","article-title":"Nursing domain of CI governance: recommendations for health IT adoption and optimization","volume":"22","author":"Collins","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"2020110612390954000_ocy034-B18"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/848\/34150106\/ocy034.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/7\/848\/34150106\/ocy034.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:09:23Z","timestamp":1604686163000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/7\/848\/4982761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,23]]},"references-count":18,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,4,23]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocy034","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,7]]},"published":{"date-parts":[[2018,4,23]]}}}