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EHRs Are Not A 'Digital Menace'
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TestSage
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TestSage,
User Rank: Apprentice
9/27/2013 | 4:43:48 PM
re: EHRs Are Not A 'Digital Menace'
Misconceptions of EHRs should not deter the public from benefiting from their implementation. EHRs should be load tested to ensure that EHRs perform as expected. By load testing your
application with virtual users, you can ensure you'll get the right
performance before you go live. There are two schools of thought when it
comes to automated performance testing. One looks at
the back-end database and network activity to derive the performance.
The other looks at time it takes the end-user to perform a task. We
believe that true performance testing of any healthcare systems should
be tested from the end user perspective and that
is why we created our testing suite. Find out more at http://www.nrgglobal.com/healt...
MedInformaticsMD
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MedInformaticsMD,
User Rank: Apprentice
9/20/2013 | 9:30:32 PM
re: EHRs Are Not A 'Digital Menace'
IOM also admits that major impediments to knowledge of health IT risks exists and is unacceptable:

Several reasons health ITGă˘related safety data are lacking include the absence of measures and a central repository (or linkages

among decentralized repositories) to collect, analyze, and act on
information related to safety of this technology. Another impediment to
gathering
safety data is contractual barriers (e.g., nondisclosure,
confidentiality clauses) that can prevent users from sharing information
about health ITGă˘related adverse events. These barriers limit usersGăÍ
abilities to share knowledge of risk-prone user interfaces, for instance
through

screenshots and descriptions of potentially unsafe processes. In
addition, some vendors include language in their sales contracts and
escape
responsibility for errors or defects in their software (i.e., Găúhold
harmless clausesGăą). The committee believes these types of contractual
restrictions limit transparency, which significantly contributes to the
gaps in knowledgeof health ITGă˘related patient safety risks. These
barriers to

generating evidence pose unacceptable risks to safety.[IOM (Institute of
Medicine). 2012. Health IT and Patient Safety: Building Safer Systems
for Better Care (PDF). Washington, DC: The National Academies Press, pg.
S-2.]

FDA indicates likewise in the 2010 internal memo on HIT risks (PDF available at http://www.ischool.drexel.edu/... ).

-----------------

I was a reviewer of the PA Patient Safety Authority report, authored by ECRI. As at my essay at http://hcrenewal.blogspot.com/... , recommended inclusion of a "limitations" section. That recommendation was accepted.

The attempt was made, as acknowledged in the study, to glean
information about EHR-related events from, in large part, textual
analysis of narrative in
the hopes that the reporter recognized the role of IT, and reported it

using terms that could be detected by the search algorithms. In other words, the data was not "purposed" for this type of study.

It
is axiomatic that one cannot find data that is simply not present, no
matter how fancy the search algorithm. Further, passive analysis of
clinical IT risk/harms data in an industry where lack of knowledge of
causation and misconceptions abound will produce only partial results
that suggest further study is needed, and not give an indicator of just
how incomplete the results are.

Perhaps more valid is the later ECRI Deep Dive study where, in
volunteer reports from just 36 of their member PSO hospitals, in just 9
weeks 171 health IT mishaps were reported, 8 of which caused harm and 3
of which may have contributed to or caused patient death. See "Peering
Underneath the Iceberg's Water Level: AMNews on the New ECRI 'Deep Dive'
Study of Health IT Events" at http://www.ama-assn.org/amedne... . In a mere 9 weeks from 36 member PSO hospitals, ECRI received voluntary reports (generally 5% of the true total) of 171 health IT mishaps, 8 of which caused patient harm, and 3 of which may have caused the patient's death.

If one does the math, extrapolating from figures like that, the results are concerning.

We need far more study of this experimental technology, especially with studies like the ECRI Deep Dive appearing. We also need to proceed with far more caution and not make blanket statements like "EHRs are not a digital menace." In theory, they are not; in practice, the jury is not yet out due to insufficient data. However red flags are appearing that cannot be denied.

Scot Silverstein,MD
David F. Carr
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David F. Carr,
User Rank: Author
9/18/2013 | 9:36:31 PM
re: EHRs Are Not A 'Digital Menace'
It strikes me that the most dangerous part of implementing EHRs is the conversion from paper - the transition and transcription where errors like the omission of information about a prescription can creep in.

I wondered if that might be the case with Dr. Silverstein's mother, but apparently not (the prescription was listed in EHR one day and not the next, according to his account).


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