How Safe Is Health IT?

By Ken Congdon

For years now, technology vendors, the federal government, and leading healthcare technology associations have touted the potential safety benefits of health IT. These proponents highlight how EHRs can eliminate prescription and other errors resulting from ineligible handwriting, effectively aggregate patient data to track and manage hospital-acquired infections (HAIs), and improve the availability and timeliness of health information to support treatment decisions. While EHRs do offer healthcare providers (and their patients) a great number of safety advantages, the technology also introduces a new breed of potential safety hazards. For example, poor EHR software interface design or confusing information displays can contribute to clinical errors.

In an effort to better protect patients and providers in this technological age, HHS released its Health IT Patient Safety Action and Surveillance Plan at the beginning of July. This plan builds on suggestions made in a 2011 safety report published by The Institute Of Medicine (IOM), and not only promotes the use of health IT to make care safer, but also aims to continuously improve the safety of the health IT solutions in use. To HHS, achieving these goals will require the coordinated effort of existing healthcare authorities including multiple government agencies, care organization leadership (e.g. clinicians, IT staff, C-level executives, etc.), healthcare technology vendors, usability experts, and patients.

Cracking Down On EHR Technology

To date, little evidence exists to suggest that health IT poses a significant threat to patient safety. On the contrary, a database review contained in the IOM report revealed that health information systems were involved in less than 1% of reported errors. That being said, health IT has become so tightly integrated into care delivery today that the extent to which any system contributes to medical errors can often be difficult to interpret. In response, the HHS safety plan not only calls for proper training and diligence on the part of providers when using health IT, it also includes steps to ensure that health IT tools are designed correctly from the outset.

For example, ONC will use its health IT certification program to monitor how certified EHR technology functions in operational/clinical settings. This knowledge will lead to a better understanding of the risks associated with specific EHR capabilities (e.g. CPOE), and help identify ways to make the technology safer.

In addition, ONC expects to update its standards and certification criteria to include new safety enhancement measures. These measures will require developers of certified EHR technology to integrate safety principles — such as quality management and usability — into their software design and development processes.

While HHS’ new safety plan does place added scrutiny on EHR vendors, I don’t think it goes far enough. After all, healthcare providers bear almost all the risk when comes to implementing an EHR. If a patient is harmed as a result of EHR use, it’s the provider that is penalized with fines and malpractice lawsuits. It’s the provider’s reputation that takes a hit. These penalties are warranted if a provider has poor EHR workflow processes or is negligent in its use of the technology, but what about errors that stem from flawed EHR design or software glitches? Why should providers be held solely responsible for technology malfunctions beyond their control? Shouldn’t vendors share financial and legal liability for these errors as well? After all, ONC is promoting a “shared responsibility” for patient safety here. It’s difficult to create an environment of shared responsibility if one stakeholder bears most of the burden. I believe EHR vendors should have more stake in the game. They should be held accountable if the design and programming of their products are the direct cause of patient errors.

Create A Culture For Patient Safety

Realizing that the scales of “shared responsibility” will likely always be tilted toward the health provider, hospitals and physicians practices must ensure they do everything in their power to utilize health IT is ways that improve patient safety, not hinder it. For example, ONC encourages healthcare providers to properly train and educate its employees on the proper use of health IT. The Office is even taking steps to strengthen health IT patient safety efforts by making health IT safety curriculum mandatory as part of the education and training of health IT professionals.

Specifically, ONC encourages providers to implement the following strategies to support patient safety:

• Establish a strong executive and clinical leadership commitment to patient safety, and make it a priority enterprise wide;
• Engage with your EHR vendor/partner to create an environment of shared responsibility for patient outcomes;
• Select solutions that will connect data from clinical and other related health systems, and also support clinical and administrative workflows;
• Create and sustain an approach for managing clinical content and change requests;
• Design mechanisms and metrics to promptly identify, escalate, and remediate health IT-related safety issues; and
• Provide user training and periodically assess competence.