Let's move from patient safety research to patient safety accountability

I've expressed concern before that ONC paints a Pollyanna portrait of its success. 

So I found its recent issue brief on health IT and patient safety refreshing.

Yes, it's a very rosy picture on how health IT has made great strides in improving patient safety, and that ONC expects this trend to accelerate. But it cites several studies to back up its position that health IT and Meaningful Use functions have had a "dramatic" effect on improving patient safety. These include things like better monitoring of patients with chronic conditions, more adherence to clinical protocols and reduced medication error rates.

Importantly, the issue brief was more candid and balanced than some of ONC's prior reports on other topics. It acknowledged that EHRs, in some respects, have had a negative impact on patient safety, with unintended consequences that "detract" from their overall success. And it recommended further study on EHRs and patient safety, such as how interoperability will impact or improve safety; what can be learned from human factors engineering,  and now to make health IT itself safer, specifically calling for more research on those unintended consequences.

This is a step in the right direction.

Health IT-related patient safety issues have been increasing, not surprisingly, with the corresponding rise in EHR use. Many of the problems stem from design issues, such as configuration errors, data display problems, and discrepancies. Moreover, EHRs often are not designed to catch many of these errors.

But some of the problems stem from or are exacerbated by human error. EHR copy-and-paste errors don't occur in a vacuum; it's the individual using the function incorrectly that's causing mistakes in the records that can lead to patient harm. It may be a design issue that an EHR can have multiple records open at once, but it's the clinician who mistakenly inserts patient information into the wrong record that can hurt the patient.

The Joint Commission seems to understand that the fault for EHR-related adverse patient safety events lies with both vendors and users, noting in recent alerts that these events are caused by a combination of factors, including usability issues, data related errors, workflow and communication issues, and hard ware or software problems.

So the bigger question is not so much who to blame, but how to proceed. It has been suggested that the issue not be left in the hands of the developers, but that the industry undertake "collaborative" research on health IT-related patient safety.

It's fine to conduct more research. But then what?

The industry should be turning now to accountability and fixing these health IT patient safety problems. We know that providers are accountable. After all, if a patient is harmed, the provider is on the hook. It's already been identified that providers need to be better trained on avoiding health-IT related errors; ONC, the Joint Commission and others are attempting to address that issue.

But there's still no required accountability on the vendors designing the systems. There's still no required reporting of EHR-created adverse patient events to some central data base. There's still no requirement that these design issues be corrected. They're not even being asked to do the research by themselves. The existing safety plan and vendor codes of conduct don't require vendor corrections.

We can continue to study the problem, but we already know it's there. Now let's take some steps to apply the research and make sure responsibility is shared when appropriate to improve patient safety further. - Marla (@MarlaHirsch and @FierceHealthIT)

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