Ross Koppel: To improve patient safety, first fix EHR software

To reduce health IT-related patient errors, the industry must start by correcting persisting software design problems, according to an editorial published recently in BMJ Quality and Safety.

Ross Koppel, M.D. (pictured), from the University of Pennsylvania, writes about a recent HIT Safety Framework recommended earlier this year by two of his colleagues: Dean Sittig, professor in the School of Biomedical Informatics at the University of Texas; and Hardeep Singh, chief of the health policy, quality and informatics program at the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center.

Koppel says their framework is "misdirected" in certain ways and contains errors in the assumptions they made. The proposed Safety Framework calls for better measurement of HIT safety issues, housing on continuous quality improvement and sociotechnical approaches.

Koppel notes that the framework's authors make some good points, such as the need for strategies to measure safety concerns, the fact that none of the data on errors has been collected from vendors, and that there has been too much attention focused on meeting Meaningful Use, and not enough on measuring patient safety.

However, he disagrees with their reliance on error reporting, since they fail to acknowledge the extent of our ignorance about electronic health record-related errors. The data is "defeated" by a slew of EHR software problems, such as a "dreadful" presentation of data, pop-up and drop-down lists that end up hiding screens, alerts that obscure the screen, lost information and lack of interoperability. Koppel also says the authors erroneously place the blame on human error rather than on the software.

"We need to fix the software and interoperability to reduce errors," Koppel says. "Reporting errors is essential, but so many errors are unknown, are attributed to poor implementation or user incompetence, and are made difficult to report by clunky mechanisms, legal concerns, and normative pressures."

EHR-related patient safety problems continue to plague the industry. The National Institute of Standards and Technology, the Office of the National Coordinator for Health IT and other organizations have released guidance to help providers improve patient safety when using EHR systems, but software design issues persist.

To learn more:
- read the editorial (.pdf)

Suggested Articles

Roche, which already owned a 12.6% stake in Flatiron Health, has agreed to buy the health IT company for $1.9 billion.

Allscripts managed to acquire two EHR platforms for just $50 million by selling off a portion of McKesson's portfolio for as much as $235 million.

Artificial intelligence could help physicians predict a patient's risk of developing a deadly infection.