Electronic Health Records: First, Do No Harm? - InformationWeek

InformationWeek is part of the Informa Tech Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them.Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

IoT
IoT
Healthcare // Electronic Health Records
Commentary
6/26/2014
09:06 AM
David F Carr
David F Carr
Commentary
Connect Directly
LinkedIn
Google+
Twitter
RSS
50%
50%

Electronic Health Records: First, Do No Harm?

EHRs are commonly promoted as boosting patient safety, but are we all being fooled? InformationWeek Radio investigates.

long after that. "Having a mature EHR system clearly does not eliminate EHR-related safety concerns," they wrote, pointing out that most of the issues they studied could be classified as "unsafe technology" rather than unsafe use of the technology (which would include usability and training issues).

In keeping with Silverstein's point, the report's authors also point out that the VA is unusual among health systems in having an established reporting system for tracking EHR-related safety concerns. "We just don't have similar data from the private sector," lead author Hardeep Singh said in an interview. Singh is a safety researcher at the Veterans Affairs Center for Innovations in Quality, Effectiveness, and Safety at Michael E. DeBakey VA Medical Center and at Baylor College of Medicine. Federal regulators require hospitals to gather all sorts of quality data in support of the Meaningful Use program, but "right now, those are mostly focused on getting people to use these systems as opposed to using these systems safely," Singh said.

The best way to respond to EHR safety risks is to track them and learn from them, Singh says. In addition to promoting the adoption of national reporting standards for EHR safety, he worked on the creation of a set of Safer Guides published with the support of the federal Office of the Coordinator for Health IT, which emphasize ways healthcare organizations can enhance their patient safety programs and improve their own performance.

[Learn more and ask your own questions: Tune into InformationWeek Radio's Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. ET.]

Often, problems can be traced to both computer and human errors. One example, noted in the review of VA data: "a patient was administered a dose of a diuretic that exceeded the prescribed amount. This error occurred due to a number of interacting sociotechnical factors. First, a pharmacist made a data entry error while approving the order for a larger-than-usual amount of diuretic. Although a dose error warning appeared on order entry, this particular warning was known to have a high false positive rate. Owing to diminished user confidence in the warning's reliability, the warning was over-ridden. The over-ride released the incorrect dose for administration by nursing staff. The nurse, unaware of the discrepancy between the prescribed amount and the amount approved by the pharmacist, administered the larger dose."

This isn't a system error per se, except that a feature designed to improve patient safety (the dosage alert) was mistrusted by the staff. Known as "alert fatigue," the issue of excessive and often erroneous alerts is one of the toughest user interface and usability challenges in health IT.

The study identified four main categories of EHR safety hazards:

  • Unmet display needs: The system fails to clearly display the information needed for clinicians to make the right decision.
  • Software modifications: Upgrades, modifications, or configuration errors make the software malfunction.
  • System-to-system interface errors: Failures associated with data exchange between EHRs or between components of the same system.
  • Hidden dependencies in distributed systems: One component of the EHR is unexpectedly or unknowingly affected by the state or condition of another component. For example, the transition of patients between wards or units not reflected in the EHR resulting in missed medications or orders.

While admitting he has probably contributed to some pessimism about the state of the art, Singh believes the net effect of digitizing health records is positive -- or will be, in the long run. "Right now, we're still in a learning process, but there is no going back," he said. On the other hand, the rate at which the government has been pushing for the adoption of health IT is a legitimate cause for concern, he said. "Its rapid pace of implementation jeopardizes things. Most of the vendors who are focused on Meaningful Use and ICD-10 are doing it with systems that were mostly meant for billing," he said.

One of Silverstein's themes is the need to distinguish between the business IT of hospital operations and the requirements of clinical informatics. His advice to hospital CIOs: "Business computing people, who are the people who staff most hospital IT departments, fundamentally need to admit they do not know healthcare. They literally are not qualified to judge good health IT versus bad health IT."

Sounds like an issue worth debating, which is why I invite you to not only tune in but actively participate in our InformationWeek Radio show, Tuesday, July 1, at 2:00 p.m. ET. You'll be able to ask questions through a text chat during the show and after the conclusion of the audio program.

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, an InformationWeek Healthcare digital issue.

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio
We welcome your comments on this topic on our social media channels, or [contact us directly] with questions about the site.
Previous
2 of 2
Next
Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
7/1/2014 | 3:14:29 PM
IW Radio Replay: Is Digitizing Healthcare Making It Less Safe
If you missed attending our program live, the replay is available now:

http://www.informationweek.com/radio.asp?webinar_id=103&_mc=sm_iwk_editor_davidcarr
tekedge
50%
50%
tekedge,
User Rank: Moderator
7/1/2014 | 12:06:46 AM
EHR
The comment by Mr Silverstein Eliminate Bad Health IT made me pause and think how unhealthy IT can be treated to become healthy and we can record it's treatment in ITHR
tekedge
50%
50%
tekedge,
User Rank: Moderator
7/1/2014 | 12:00:01 AM
EHR
The concept of EHR is really innovative. But itS basiS is still involves humans updating it and should be done regularly and accurately. Mistakes here can make a difference between life and death and that is what frightens most people
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
6/30/2014 | 11:31:26 AM
Informatics vs. IT: Doctor Revolt Against EHR at Athens Regional Medical Center
One example points to of "bad health IT" is the recent Athens Regional Medical Center revolt by doctors who began resigning en masse, saying the new computer system being implemented there "endangers patients" (see Silverstein's blog). The issue was not ncecessarily the software program chosen but the lack of involvement of medical personnel in the selection, implementation, and rollout of the technology.

The doctors made sufficient noise over this that the CEO of the medical center subsequently resigned.

Near the end of the column, I quote Silverstein on the difference between business-oriented IT for hospital operations and health informatics. One of his themes is that health IT implementations are too often led by CIOs and project leaders with inadequate appreciation for informatics as a discipline. That's one of the points I plan to discuss with him as part of the online radio program.

In defense of hospital CIOs, I should mention that many I've spoken with are quick to acknowledge that they are not and cannot be the leaders on the clinical implementation of these systems and that their organizations' CMIOs, CNIOs, and other clinical leaders are important partners in a successful EHR implementation. But how often is that reality rather than rhetoric?
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
6/30/2014 | 11:05:33 AM
Re: Will you address gag clauses
Legal restrictions on the reporting of EHR safety pitfalls are one of several gaps in the regulation of health IT Silverstein addresses in this post on the FDA's ruling that health IT represents a "sufficiently low risk" that it need not be regulated like a medical device. I'm sure he'll be quite happy to address why gag clauses in EHR vendor contracts are inappropriate.
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
6/30/2014 | 10:06:57 AM
Re: It's all about Chosing a right Vendor
Particularly in the larger, hospital implementations, I don't think you can say picking the right vendor is the end of the story. Even if the base software package is perfect (which it's probably not), there are dozens of issues with training, testing, adapting procedures, and so on that can either go right or wrong.
SteveRobbin
100%
0%
SteveRobbin,
User Rank: Apprentice
6/27/2014 | 9:15:36 PM
It's all about Chosing a right Vendor
I think the main reason of the problems which discuss above are" Not chosing the right EHR Vendor" . I in my office using Nortec Software Inc. Electronic Health Records Software and i didnot find any single problem which mention above. Why? because when i contact Nortec management for their software they take complete knowledge of my work and requirement and after sevral meetings we decied which package is best for my office.
JamesK888
50%
50%
JamesK888,
User Rank: Apprentice
6/27/2014 | 2:40:20 PM
Will you address gag clauses
A recent RAND study indicates that "Vendor gag clauses... limit the ability of researchers, providers, and regulators to access data regarding EHR glitches that may jeopardize patient safety..."

Can you ask Dr. Silverstein to comment on this?

Thanks!

http://www.rand.org/pubs/research_reports/RR308.html
jagibbons
50%
50%
jagibbons,
User Rank: Ninja
6/26/2014 | 11:05:22 AM
Worrisome
While I also believe there will be eventual benefits in adopting EHR, the current state, at least as outlined in this article, is very worrisome. Mistakes like those shared can be very costly to the patients, as well as the providers if serious injury or death results. Practitioners across the entire market need access to data about their patients, but it needs to be secure and accurate.
Slideshows
9 Steps Toward Ethical AI
Cynthia Harvey, Freelance Journalist, InformationWeek,  5/15/2019
Commentary
How to Convince Wary Customers to Share Personal Information
John Edwards, Technology Journalist & Author,  6/17/2019
Commentary
The Art and Science of Robot Wrangling in the AI Era
Guest Commentary, Guest Commentary,  6/11/2019
White Papers
Register for InformationWeek Newsletters
Video
Current Issue
A New World of IT Management in 2019
This IT Trend Report highlights how several years of developments in technology and business strategies have led to a subsequent wave of changes in the role of an IT organization, how CIOs and other IT leaders approach management, in addition to the jobs of many IT professionals up and down the org chart.
Slideshows
Flash Poll