The widespread adoption of electronic health records is a double-edged sword for the healthcare industry with the potential for both improving and harming patient safety.
Earlier this month, data from the 2013 National Ambulatory Medical Care Survey of Physician Workflowrevealed that physicians using EHRs that met the meaningful use criteria were significantly more likely to report safety improvements than physicians that were not using EHRs. In addition, three times as many physicians reported that their EHR prevented a potential medication error than caused one.
“Even with this progress on EHR adoption and the improvements in quality and safety, we realize that patient safety events related to health IT can still occur,” wrote Amy Helwig, M.D., from ONC’s Office of the Chief Medical Officer, and Judy Murphy, R.N., director of the Office of Clinical Quality and Safety in a recent blog. “New analyses show that the most common types of health IT-related events involve medications and most often involve data input or display errors, software configurations, and/or interfaces between systems.”
Last year, patient safety organization ECRI Institute compiled a top ten list of technology-related issues that jeopardize safety. Issue #4 was patient/data mismatches in EHRs and other health IT systems, while #5 was interoperability failures with medical devices and health IT systems.
Under contract to ONC, ECRI and the RAND Corporation conducted separate research that found that health IT safety often competes with other pressing priorities for limited resources within healthcare organizations. The report concluded that EHR technology has the potential both to improve patient safety, if implemented and used correctly, and to introduce new sources of patient safety hazards.
But, Helwig and Murphy argue that ONC now has a “better understanding of the types of safety events related to health IT and, more importantly, the interventions available to prevent unintended consequences of the use of health IT tools.” To address the safety challenges associated with the use of HIT, ONC established an Office of Clinical Quality and Safety and is implementing a Health IT Safety Program to promote the safe use of EHR technology.
In addition, in collaboration with FDA, FCC, and the Agency for Healthcare Research and Quality, ONC is working on building the foundation of a Health IT Safety Center–a public-private entity to convene stakeholders to assure that risks are minimized and patient safety is protected.
Nonetheless, a big part of the problem is that a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks. “Most hospitals, even those with EHR systems, do not know their own rates of adverse events,”testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, in July before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging.
“They don’t know how often they harm patients,” Jha told senators. “However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
