Can we make health IT safe enough for patients?

Health information technology (HIT) is widely believed to be an essential modality for improving the efficiency, effectiveness, and safety of healthcare, and has its adoption has been vigorously promoted. However, the safety of commercially available HIT systems has never been independently and rigorously assessed. This paper discusses critical issues to be considered in the development of safe and reliable HIT, and identifies a group of structural impediments that may slow or prevent the arrival of HIT that is actually safe enough for routine clinical use. It argues that this situation is analogous to NASA's promotion of the space shuttle not as an experimental, risky technology, but rather as a routine, ready-for-ordinary-use resource.