Guerra On Healthcare: Health IT Safety Needs Serious Attention
Growing questions about risks can't be brushed aside.
Psychologists say people don't research problems to find solutions, but rather to support the solution they've already decided upon.
To cite a recent political example, many said the Bush administration "cherry picked" intelligence to foster support for a war that it was already committed to. In addition to the selection side, this type of analysis entails ignoring or discounting information that casts doubt upon the intended course.
I fear that the Office of the National Coordinator--the newly minted federal agency overseeing the implementation of the HITECH legislation--is falling into this trap. In my opinion, ONC can't be relied on to objectively evaluate and respond to growing concerns that electronic health records, in their current state of sophistication, bring with them as many patient safety risks as improvements.
How can the agency legislatively tasked with forcing EHR and computerized physician order entry systems into the nation's healthcare system turnaround and say it now appears those systems are actually dangerous?
Mind you, I mean "dangerous" in the sense that a gun is dangerous in the hands of someone who's never been trained to use it or, put more appropriately, dangerous in the hands of someone who's only been given an afternoon of training. And that's exactly what HITECH is doing to the healthcare industry--forcing systems with the potential lethality of guns into the hands of individuals who won't have had enough training to use them safely.
Rather than commissioning studies on EHR safety before it essentially made them a federal requirement, Congress took the word of powerful health IT lobbying groups and stuffed the politically palatable HITECH provision into the bloated American Recovery and Reinvestment Act spending frenzy. Only now do we see the industry starting the kinds of studies that will reveal whether EHRs are really ready for mainstream use. And even if they're found safe in the abstract, there's no way they can be safely deployed under the HITECH timelines.
I've been talking to people about HITECH since it was passed early last year, and I'm more convinced than ever that this legislation, and the way it is being implemented, is nothing short of irresponsible. The only way my opinion can be changed is if the Meaningful Use bar is dramatically lowered when the final regulations come out this summer.
A Policy Committee workgroup undertook a brief investigation in which it found no reason to slow ONC's push to drive HITECH home. National coordinator Dr. David Blumenthal recently cited those findings as proof that health IT safety concerns were much ado about nothing. Blumenthal said any anti-EHR concerns were based on mere anecdotes and lacked the empirical evidence necessary to cause a change in policy. But empirical evidence doesn't materialize out of thin air, and the kinds of studies that can produce it are just beginning.
For example, I recently of interviewed Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston. He's getting ready to head up an ambitious study on CPOE-related errors that should be completed in about a year. The study, funded by the National Patient Safety Foundation, will examine 200,000 reports of CPOE-related medical errors to elicit common themes and, hopefully, identify possible solutions.
It's amazing that studies like this will just be finishing as the nation's hospitals and physicians seek to qualify for Stage 1 Meaningful Use incentive funds by practicing with the very technology being investigated. What will happen if the findings don't jibe with ONC's mantra: that EMRs and CPOE are a necessary part of practicing medicine today. In fact, Blumenthal regularly makes the point that doctors who wish to consider themselves competent professionals had better get on a computer, and fast.
ONC wants to brush aside HIT safety concerns by saying the evidence of harm is all anecdotal, but studies that offer the empirical evidence ONC wants only get started after exactly such anecdotal smoke indicates fire. The problem with the current timeline is that by the time we find that fire, it may be too wild to contain.