Editor's Corner: Better roadmap needed for HIT patient safety

computer keyboard

marla hirschIt’s well established by now that while electronic health records can improve patient health and safety, they can also cause or contribute to adverse events and patient harm.

This is no doubt why the Office of the National Coordinator for Health IT has made health IT patient safety a priority issue. It’s part of ONC’s strategic plan, its interoperability roadmap, its self-assessment protocols (the SAFER guides), its health IT safety and surveillance plan and its health IT safety collaborative.

Continuing in its efforts, ONC has now released two new health IT safety reports to help the industry address health IT and patient safety.

The first report examines the most recent evidence on health IT and patient safety. It identifies gaps in research, encourages the development or refinement of existing tools or interventions that could enhance the safety and safe use of health IT, highlights information about the types and frequency of safety events and addresses the issues of usability and interoperability that can improve safety. For instance, the report informs readers of some of the major problems causing patient harm, such as failure to heed alerts, lack of patient matching, misunderstandings about time, incorrect item selection and extended EHR unavailability. Usability issues and lack of interoperability also contribute to the problem.

The second report outlines goals and priorities in reducing health IT safety issues and provides some recommendations, such as addressing workflow, communication and medication management.

According to ONC, the two reports together highlight that health IT is dependent not just on the EHR system, but also on additional complex factors, including an institution’s leadership, culture, readiness, installation practices, training and handling of upgrades.

“The Collaborative and associated activities will bolster patient safety across the health IT community, will generate substantial efficiencies by enhancing coordination and alignment of activities, and will encourage greater levels of private investment in health IT safety," ONC Chief Medical Information Officer Andrew Gettinger writes in a blog post. "It builds on our efforts to ensure that health IT developers build their systems following usability principles; facilities and providers implement their systems and workflows to ensure they are used safely, and making sure that all the users are trained in using the new systems."

There’s no question that there are many resources to identify problems and provide advice.

But there are two major problems with this approach:

  1. Much of this is voluntary. It’s important for providers to hone in on patient safety issues and health IT. But we also know that in the hustle and bustle of treating patients, it’s hard to make time to sit down and read reports, let alone incorporate them into everyday operations. ONC itself acknowledges that these resources are “promoting” the safe use of health IT. Moreover, even some mandates intended to reduce health IT-related adverse patient safety incidents--such as the certification requirement on usability testing--appear to be treated as optional.
  1. There’s no clear process on how to get from point A to point B when it comes to reducing health IT-related patient safety problems. How can a provider reduce the number of incorrect items selected in the EHR if it’s still designed inadequately? How does the user meet a best practice of “when test reports are amended, the change is clearly visible in the EHR”? How do you determine which alerts to heed? How do you prioritize “leadership” and “culture?" 

We all want better patient safety with health IT. But there must be more to it than simply pointing to problems and highlighting theoretical solutions. We need a clearer roadmap and more directives to go down that road. We know what the problems are. The next step is to eliminate them. - Marla (@MarlaHirsch and @FierceHealthIT)

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