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11/12/2012
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EHRs Among Today's Top Health IT Hazards

Inaccurate patient information, mobile distractions and med device interoperability are putting patients at risk, says recent report from ECRI.

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Patient/data mismatches in EHRs and other health IT systems, distractions from mobile devices, and interoperability mishaps are just a few of the current health IT hazards that could harm patients. So says a recent report by ECRI Institute, which offers publications and consulting on patient safety, quality improvement, risk management, and more.

"Top 10 Health Technology Hazards List for 2013" is the sixth annual health IT hazard report published by ECRI. Jim Keller, vice president of health technology evaluation and safety at ECRI, said in an interview with InformationWeek Healthcare that the institute looks to various databases, clinical literature, trends across the industry, and clinicians and health IT professionals to narrow down its hazard list and determine the top 10.

Wrong EHR information, distractions from mobile devices, and interoperability failures are new additions to this year's list. To illustrate the danger of inaccurate EHR data, Keller said to imagine lab results entered incorrectly into a patient record. "Then, it's possible for a clinician to take action on those lab results and treat the patient incorrectly."

[ For the latest development on Meaningful Use, see Meaningful Use Stage 2 Rules Finalized. ]

"... [O]ne of the things we emphasized in the report is to make sure when you're purchasing a new EMR system or [upgrading] a system, you're testing these products and [are] looking for the possibility data can be associated incorrectly with the wrong patient file," Keller continued. Additionally, he said, organizations can avoid this problem by having patient association processes in place to improve the accuracy of the information they're gathering. One way to do that? Barcoding.

Smartphone distractions are another key hazard and is growing due to the adoption of BYOD programs, Keller said. By way of illustration, he said, "Look at your personal use of emails. A lot of us are inundated with messages; some of it is noise and some is legitimate. It's easy for a regular user of email to miss an important email message, and that same scenario can happen with clinicians relying on laptops and tablets for clinical information." Mobile distractions can also occur while a caregiver talks with a patient and becomes preoccupied with information popping up on his mobile device, whether personal or not. "Like texts messages or tweets," Keller said. "We talk to organizations about implementing policies for how clinicians use their digital devices in patient interaction scenarios…some hospitals will allow for smartphones to be used, but they can't have personal data on them…BYOD is like the Wild West."

Lastly, the communication between mobile devices, and the communication sent to an EHR thereafter, can pose a serious threat to patients, said Keller. One example, he said, is communicating alarm data from a ventilator to a patient monitor. The purpose of this transmission of data is to display information on the patient monitor from the ventilator, yet, the alarm status from the ventilator, for example, can be changed or even dismissed when this exchange of data occurs. And once this data is entered incorrectly into the patient monitor, it can also be input incorrectly into the patient EHR.

"One of the things we emphasized in the report is that there's a new and important standard [focusing] on a risk management standard specifically for managing data across hospital networks," said Keller. "Hospitals haven't broadly adopted the standard, and we're encouraging hospitals that if they're moving toward interoperability with medical devices and EHRs, they consider the risks associated with doing that."

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)

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M2SYS
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M2SYS,
User Rank: Apprentice
12/11/2012 | 1:17:20 PM
re: EHRs Among Today's Top Health IT Hazards
There a couple of incomplete truths in the NY Times article:

1. The assertion that palm vein biometrics will prevent duplicate medical records at the point of enrollment. It can't.

2. The assertion that palm vein biometrics protects against patient fraud at the point of enrollment. It can't.

Of course there aren't any foolproof means of security so you are right in saying that the statement that biometrics "most certainly eliminates the risk of fraud" is not a fair one to make. Acknowledge that. However, biometric patient identification in the right setting stands the best chance of preventing fraud than any other security measure in place currently at hospitals.

As to the statement "it's more about how you implement your solution, not the solution itself" -- this is pretty vague and if it were backed with more research and examples, it might have more validity.
jaysimmons
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jaysimmons,
User Rank: Apprentice
11/19/2012 | 4:15:23 PM
re: EHRs Among Today's Top Health IT Hazards
MTECHNOLOGY000,

What parts of the NY Times article were incomplete truths? I think saying that biometrics "most certainly eliminates the risk of fraud" is a pretty bold statement. The general rule I tend to go by with security is if someone can make it, someone else can break it. It may make it much harder for someone to fake someone's identity, but nothing is or will ever be completely foolproof and eliminate fraud. As srparent says in a below comment, it's more about how you implement your solution, not the solution itself.

Jay Simmons
Information Week Contributor
AustinIT
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AustinIT,
User Rank: Apprentice
11/15/2012 | 2:52:53 PM
re: EHRs Among Today's Top Health IT Hazards
Yes, Mr. Keller, the Sky could fall tomorrow. But, what is the likeyhood of that happening?
This smacks more of "what if" rather than pointing out real problems. Why? Because it assumes that Docs and EHR vendors et. al are complete idiots when it comes to designing and using technology.
For instance, in EHRs there are many checks and balances when it comes to auto matching Lab reports with patient identities. If it cannot match on several criteria, then an exception is thrown and the person responsible for Lab results is notified to make a manual check.
Barcoding? No way that is going to be accurte enough to trust it. What? Are we going to Tattoo a barcode on each patient?
If a Doc or other medical professional is Tweeting, checking email, browsing the web, etc. during a patient encounter, then they likely should be sanctioned and/or fired. I think they know (or certainly should know) better.
The example given of a patient monitor receiving incorrect information is probably the only point in the article that I would agree could pose a serious problem. However, these systems need to be thoroughly tested (and monitored after implementation) before being integrated into the HIT process.
Stephane Parent
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Stephane Parent,
User Rank: Strategist
11/14/2012 | 8:41:55 PM
re: EHRs Among Today's Top Health IT Hazards
I take exception to your statement that "more moderns means of patient identification [...] offer more distinct advantages.."

Just because something is newer does not make it better. Sometimes is about how you implement your solution, not the solution itself.
M2SYS
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M2SYS,
User Rank: Apprentice
11/13/2012 | 4:51:23 PM
re: EHRs Among Today's Top Health IT Hazards
Paul, appreciate your feedback. It should be noted that the recent NY Times article you are referring to does not tell the complete truth about how biometric technology for patient identfication works. With that in mind, how can one reasonably accept any of the arguments made in the article with conviction? If the author of the article didn't do proper due diligence when researching the article, it becomes a lot less credible and instead more bias than fact. Biometrics most certainly eliminates the risk of fraud - if it is the right version of the technology.

The fact of the matter is that referring to that NY Times article is not a strong argument for Information Week. It should be noted that there are some biometric patient identification systems available for healthcare that will soon use credit bureaus to check a person's claimed identity before enrolling and linking their biometric template to their medical record in response to concerns about patients faking their identity at the point of enrollment. This provides yet another control measure to ensure that the person is who they claim to be before the point of enrollment. What will be Ms. Dixon's argument then? Don't you think that whatever the truth is about how the tech works, an organization like the World Privacy Forum will continue to be biased on the side of privacy? And how exactly did they become an expert worthy of quoting about how this technology actually works?

Although I understand that the author's intent for the article wasn't to report on the current state of biometrics for patient identification, but certainly we would expect that the journalist would accurately report how this technology works to make her arguments more credible.
pcerrato10
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pcerrato10,
User Rank: Apprentice
11/13/2012 | 4:15:50 PM
re: EHRs Among Today's Top Health IT Hazards
MTechnology000
Thanks for your feedback. I should point out however, that biometrics technology doesn't eliminate the risk of fraud. A recent NY Times article points out:
G«£LetG«÷s say someone makes a fake ID and goes in and has their photo and their palm print taken as you. What are you going to do when you go in?G«• said Pam Dixon, the executive director of the World Privacy Forum, an advocacy group in San Diego. G«£Hospitals that are doing this are leaping over profound security issues that they are actually introducing into their systems.G«•
http://www.nytimes.com/2012/11...

Paul Cerrato
Editor
InformationWeek Healthcare
M2SYS
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M2SYS,
User Rank: Apprentice
11/12/2012 | 9:28:25 PM
re: EHRs Among Today's Top Health IT Hazards
Great article Michelle. This is a fascinating report and great insight on how health IT can jeopardize patient safety, an area that most patients aren't probably thinking about on their hospital visits. Very good analysis.

I would take exception to one assertion in the article however and that is the use of barcoding. Although barcoding is a viable means of patient identification, it is susceptible to errors, patient swapping and a high degree of human error than say, using biometrics for patient identification which removes the ability for fraud and significantly reduces error rates. Biometrics also provides two factor authentication, by for example, combining facial recognition with iris recognition which also significantly reduces chance of error by medical staff, something barcoding can not provide.

It's important that healthcare professionals know that more modern means of patient identification are available and offer more distinct advantages than more antiquated methods to help keep patient safety levels as high as possible.
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