90 Healthcare Quarterly Vol.12 Special Issue 2009 T he reduction of medical errors has been a driving force behind many healthcare administrators’ and researchers’ efforts to implement healthcare information systems (HIS) (e.g., electronic health record systems, computerized physician order entry [CPOE]) and other health technologies in Canada and worldwide. Along these lines, in the 1990s a number of influential published papers demonstrated that the ability of HIS to reduce medical errors can be significant (Bates et al. 1999). More recently, research has emerged clearly showing that poorly designed, implemented, customized and operated HIS have the potential to cause or facilitate new types of errors, often referred to as technology-induced errors, technology-facili- tated errors or unintended consequences (Ash et al. 2007; Borycki and Kushniruk 2008; Koppel et al. 2005; Kushniruk et al. 2005). For example, Koppel et al. (2005) were able to observe and identify real-world clinical situations that may lead to technology-facilitated errors involving HIS and devices. Thus, it is important to be able to understand both the intended and unintended impacts of HIS. Although much of this research has demonstrated that technology-induced errors are a concern that warrants significant attention and caution when implementing such systems in healthcare organizations (Joint Commission 2008), most of this research has involved the use of methodolo- gies (i.e., observational research, interviews, ethnography) that allow for the unintended consequences of technology use to be identified only after the technology has been implemented in a real-world setting (e.g., Ash et al. 2007; Koppel et al. 2005). Toward an Integrated Simulation Approach for Predicting and Preventing Technology- Induced Errors in Healthcare: Implications for Healthcare Decision-Makers Elizabeth M. Borycki, Andre Kushniruk, Elizabeth Keay, James Nicoll, James Anderson and Marilyn Anderson Designing Safer Systems Abstract 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 frame- work 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 compu- terized 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 inter- face 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.