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11/9/2006
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New Health Panel Aims To Identify Risks And Challenges Of E-Health Systems

Pioneers in the deployment of digital health record systems want to share the lessons they've learned about the pitfalls, challenges, and safety risks of implementing e-health systems.

Early adopters of technology often learn the hard way what works and what doesn't. But now some pioneers in the deployment of digital health record systems want to share with other health-care providers the lessons they've learned about the pitfalls, challenges, and safety risks of implementing E-health systems.

A new national advisory panel was launched this week to study the safety and effectiveness of E-health records. The committee doesn't yet have a formal name.

The panel is being spearheaded and initially funded by Geisinger Health System, which 10 years ago began digitizing the medical records of its 2 million patients in rural Pennsylvania. Also on the panel are representatives from other early-adopters of E-medical records, including the Regienstrief Institute in Indiana and Kaiser Northwest Health Plan. In addition, the panel also includes representatives from academia, as well as industry and philanthropic organizations.

While government and industry researchers in recent years have studied the potential benefits in quality-of-care, patient safety, and cost-savings that can be generated by widespread adoption of e-health record and other clinical IT systems, there hasn't been as much attention paid to the "gaps" of safety and effectiveness in these systems as they're being deployed, says Dr. Ron Paulus, a medical doctor and Geisinger's chief technology and innovation officer.

The implementation of E-health records, E-prescription, and computerized physician order-entry systems mean big disruptions and changes in workflow and processes for doctors and nurses. Plus, the integration of disparate clinical systems -- like linking E-health record applications from one vendor to the E-prescription system of another vendor -- can also present interoperability challenges. All of these factors can potentially put patients at risk, he says. "We want to provide information to identify risk areas and how to mitigate the risks," he says.

Some risks can lead to deadly outcomes. Paulus cites a study published in one medical journal that reported an unexpected increase in patient mortality after the installation of a commercial computerized physician order-entry system at one children's hospital.

While 100% of Geisinger doctors for the last five years have been using E-health records from Epic Systems, things haven't always gone smoothly as Geisinger rolled out new applications and systems, he says.

For instance, in addition to the E-health records, Geisinger had also been using for a number of years a "great" pharmacy system from another unspecified vendor that "people were happy with." However, as Geisinger planned to roll out an Epic computerized physician order entry system, or CPOE, Geisinger discovered that it wouldn't "work safely" with the existing pharmacy systems.

So, even while the CPOE pilot was going on, Geisinger decided to de-install the pharmacy system. "It was too risky to integrate with a different vendor's CPOE," he says. There were too many "differences in data" between the two systems, such as when doctors needed to look up a drug before ordering it for patients, he says.

Paulus says the panel is aiming to develop a database that will allow health-care providers to share those kinds of lessons-learned, as well as best practices. "A comparative database will help so that not everyone needs to make the same mistakes," he says.

This is particularly important for smaller physician groups that are considering deploying E-health or E-prescription systems, but don't have the luxury of hiring consultants or a full-time technical staff, he says.

"I'm all for the dissemination of lessons-learned," says Dr. Carol Diamond, a member of the new panel and managing director of health programs at Markle Foundation, a philanthropic organization focused on ways to improve health care through IT.

"I think there is a willingness among health-care providers to share their lessons and ideas because of the broader mission" of improving health-care quality, she says."There's a lot that can be learned from early adopters, but there are also different issues that smaller providers face," she says. "The committee is trying to bring as much knowledge to bear as possible for all."

In addition to Diamond and Paulus, the other members of the committee are:

Dr. James Walker, Geisinger chief medical officer and founder of the new panel; Pascale Carayon, Procter & Gamble Bascom Professor in Total Quality at the University of Wisconsin and an expert in human factors and systems engineering in health care and patient safety; Dr. Homer Chin, MD, medical director of Kaiser Northwest Health Plan; and Nancy Leveson, Professor of Aeronautics and Astronautics at MIT, and an expert on software engineering and safety of software-controlled systems.

Also on the committee are Clement J. McDonald, MD, director and research scientist, The Regenstrief Institute and professor of medicine at Indiana University School of Medicine; and Dr. John Tooker, MD and CEO of the American College of Physicians.

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