Hospital Impact: ONC's new 'pick list' report an opportunity to make EHRs safer

Sign that says "changes ahead"
Marla Hirsch
Marla Durben Hirsch 

Reducing EHR errors that can harm patients is a front-burner issue for the Office of the National Coordinator of Health IT (ONC), and the agency continues to break new ground. The latest is new guidance based on a very specific review of medication “pick lists” used in ambulatory care settings.

RELATED: ONC report tackles EHR drug 'pick list' errors

The new report builds on documents released earlier this year that outlined some of the EHR-related errors that pose a risk to patients, including failure to heed alerts, lack of patient matching and incorrect item selection as well as some general suggestions to reduce safety problems.

These efforts dovetail with some of ONC’s other initiatives, such as the publication of self assessment tools and creation of a health IT safety center.  

But this report drills down deeply into the pick list problem. In a related blog post released November 17 Andrew Gettinger, M.D., chief medical information officer of ONC’s office of clinical quality and safety, and Marcy Opstal, the office’s health scientist (informatics), note six “available and beneficial straightforward measures that were not currently being used by many organizations in their processes for ordering medications using an EHR.”

Those recommendations are:

  1. Use specific design features to reduce wrong-patient pick list errors, such as including a patient’s photograph in the record
  2. Standardize the names of drugs listed in the EHR
  3. Implement best practices to organize, design, and configure pick lists, including the standardized drugs being prescribed through the EHR
  4. Create a summary review screen that can be viewed before a medication order is completed
  5. Make it easier for ordering clinicians to correct or revise incorrect orders and for the system to track those circumstances as a means to identify areas in which EHR improvements might be considered
  6. Provide all patients with lists of their current medications, including a description of why each medication is prescribed

This report may be particularly helpful to stakeholders since it’s so specific.  For instance, it should be easy to include a patient’s photo into a medical record to spark aa clinician’s recall of who the patient is and to provide patients with lists of the medications so they can catch errors themselves.

But this report may go even farther.

It may also provide an opportunity to make vendors more accountable for design and functionality flaws.  

For instance, the report particularly points to the lack of usability, the failure to use standards for drug names and descriptions and insufficient options for local configuration as features that vendors should be working on.   It has been pointed out that some vendors have not been complying with the usability testing and other requirements in the certification rule.  

This may be a great issue for ONC to tackle with its new direct oversight and review authority of certified EHR technology. The new rule expanding ONC’s authority specifically calls for ONC’s involvement in areas of potential risk to patient safety.

The report could also provide a catalyst for making vendors directly accountable to patients.  The report states that implementation of its recommendations requires providers and vendors to “work together” to effect these patient safety improvements.

We know that EHRs can increase providers’ medical malpractice liability. So if a vendor doesn’t help solve these problems, maybe patients harmed by a pick list or other EHR-related error should sue the vendor as well as the provider, the way they do now when a drug or medical device is a contributor to patient harm. That might get vendors to join the patient safety bandwagon.