From poor EHR design and implementation to certification standards that set a “low bar” and potential for patient harm during system transitions, Andrew Gettinger, M.D., raises the alarm about safety threats, interoperability roadblocks and other problems with electronic health records.
“I worry about three areas in health IT and safety.” Gettinger, the chief medical information officer and executive director of the Office of Clinical Quality and Safety for the Office of the National Coordinator (ONC), says in a Patient Safety Network podcast:
The design process: That includes making sure software makes sense, “that the screens are not overly busy, that they don't tax the user, that colors are used in a way that doesn't preclude colorblind people from seeing the appropriate cues and that the navigation is designed in a way to decrease the likelihood or frequency of doing something on the wrong patient,” he said. Software has “lots of room to improve,” here, he says.
EHR implementation: “We've learned that even really well-designed software can be made very challenging for clinicians when the implementation isn't done well,” he says. “The people doing the implementation are frequently not clinicians. Because it's so costly to pull people from practice, or there aren't enough clinicians to meet the clinical demands. So the decisions made by the implementation team may not be the best decisions.”
Clinician training: “The analogy I use for this is getting on a plane where the pilot hasn't been through the simulator,” says Gettinger, who led the EHR development at Dartmouth. “If I were to go back to our large-scale deployment, I would have invested far more time in developing EHR simulations, getting our software configured, then making sure our clinicians played with the systems more before they started using them to care for patients.”
But that’s just the start of Gettinger’s concerns, which include alert fatigue, low certification standards, the lack of a national patient identifier and the struggle to achieve interoperability. He also calls out the threat of patient harm during deployment of new EHRs. “Most of us who have been at that ground level think that there probably is underreporting—that those transitions actually do cause substantial negative outcomes.”
In order to get ONC’s safety collaborative off the ground, “we need Congress to fund it,” he says. “And we need that additional authorization to give protection to developers and implementers beyond what we have today.”
You can listen to the podcast—with Robert M. Wachter, M.D., professor and chair of the department of medicine at the University of California, San Francisco, in the interviewer role—here.