In a November 1, 2011 Editorial, Kate Ackerman, Managing Editor for iHealthBeat, wrote an article titled “Health IT: A Boon or Bane for Patient Safety?” In the article, Ackerman summarized the findings of a meeting of the American Medical Informatics Association’s 35th Annual Symposium on Biomedical and Health Informatics, and pointed out that although Health IT has the potential to improve patient care, the risk for unintended patient safety consequences is significant.
When using Health IT, including EHRs, it is important to ensure that the tools and systems are being used optimally. Otherwise, the risks — according to Dean Sittig, a professor of biomedical informatics at the University of Texas Health Science Center at Houston — are the following:
- Lack of availability of an EHR systems, e.g. due to a power outage;
- Incorrect use of an EHR system;
- Malfunction of an EHR, e.g. due to a logic or software problem; or
- Incorrect interaction of an EHR with another health IT system, e.g. messaging format incompatibility.
On November 8, the Institute of Medicine (IOM) announced the release of a report titled, “Health IT and Patient Safety: Building Safer Systems for Better Care,” which calls for greater oversight by the public and private sectors with regard to the use of a broad set of health information technologies. A lack of published evidence is available to quantify the risk associated with health IT; however, “serious errors involving these technologies — including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data — have led to several reported patient deaths and injuries.”
The report makes recommendations regarding the establishment of a reporting mechanism to track Health IT-related deaths, injuries, or unsafe conditions. Policy issues also need to be addressed to encourage the sharing of safety-related issues among care providers. Current “hold harmless” clauses between vendors and providers shift the liability for unsafe use of health IT to the providers, greatly discouraging the reporting of unsafe technologies or functions.
There are many potential areas for improvement of safety when using EHRs. One of these is the need to focus on design and usability of EHRs (as highlighted in this earlier post on AmericanEHR). In addition, mechanisms must be developed to monitor and report on problems with the use of IT on a near real-time basis in order to provide actionable warnings that are not purely based on retrospective analysis.
Some patient safety issues are product specific (related to design, usability, and other potential flaws), while others may be system-wide issues that need to be addressed, e.g. network reliability to ensure guaranteed availability of Health IT systems.
Have you experienced any patient safety issues related to your use of Health IT and EHR systems? Can you share examples of the types of problems you have encountered or warnings for others regarding problems that they should be aware of? Your comments are feedback are welcome.