i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 2 ( 2 0 1 3 ) e149–e160 j ourna l h omepage: www.ijmijournal.com National efforts to improve health information system safety in Canada, the United States of America and England Andre W. Kushniruk a,* , David W. Bates b , Michael Bainbridge a,c , Mowafa S. Househ d , Elizabeth M. Borycki a a School of Health Information Science, University of Victoria, PO Box 3050, STN CSC, Victoria, British Columbia V8W 3P5, Canada b Division of General Medicine, Brigham and Women’s Hospital, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States c ASE Consulting UK, Lytham, Lancashire, UK d College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia a r t i c l e i n f o Article history: Received 5 March 2012 Received in revised form 13 December 2012 Accepted 17 December 2012 Keywords: Health information systems safety Technology-induced errors Government policy Patient safety HIT safety Country comparisons a b s t r a c t Objective: In this paper we review progress as well as challenges encountered in Canada, the United States and England with regard to ensuring safety of health information technology. Method: A review of major programs and initiatives for ensuring safety of health information technology in the three countries was conducted. Published literature and Web resources from national programs were reviewed for relevant information. Results: It was found that in all three countries the issue of technology-induced error has been recognized as being of critical importance. The three countries have developed approaches for dealing with the issue that have some commonalities; however, they are at varying differ- ent stages of maturity, with England having the longest standing and most well developed safety programs, while Canada and the United States are at earlier stages. The types of approaches employed have included work on developing standards related to usability and interface design, certifications, directives from regulatory bodies, educational initiatives in health information technology (HIT) safety as well as research into safer HIT design and implementation methods. Conclusions: HIT promises to lead to improved patient safety. However, it has become recog- nized that if not designed and deployed appropriately, such systems can lead to new types of errors. Based on this recognition, a variety of initiatives are being undertaken in Canada, the United States and England to promote the safe design, procurement and deployment of HIT. It is concluded that improved approaches to system design, testing, regulation, error repor- ting, safety education and cross-country collaboration will be needed to further promote safer HIT. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Health information technology is expected to increase the efficiency, effectiveness and safety of healthcare worldwide. ∗ Corresponding author. E-mail address: andrek@uvic.ca (A.W. Kushniruk). Indeed a number of ambitious national projects have and continue to be undertaken in North America, the United King- dom and other countries having the objective of promoting the widespread use and adoption of healthcare information technology (HIT) [1–3]. However, in addition to a large body 1386-5056/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijmedinf.2012.12.006