By EurekAlert
Wednesday, February 3, 2010
The push is on for healthcare providers to make the switch to
electronic health records but it is hard to tell how well these
complex health information technology systems are being implemented
and used, writes a health informatics researcher at The University
of Texas Health Science Center at Houston in a Feb. 3 commentary in
JAMA, The Journal of the American Medical
Association.
To improve monitoring, Dean Sittig, Ph.D., lead author and
associate professor at The University of Texas School of Health
Information Sciences at Houston (SHIS), has called for coordinated
oversight by both the healthcare providers implementing these
systems and by government authorities.
Doctors and hospitals are racing to take advantage of billions
in federal incentives to digitize health records, Sittig said. The
monies were included in the American Recovery and Reinvestment Act
of 2009 (ARRA). "The ARRA stimulus is pushing people to take
risks," Sittig said. "It's like life. If you're late for work, you
may drive a little faster than you should. This can lead to
accidents."
Even under the best of circumstances, according to Sittig,
implementing an electronic health record system is difficult,
costly, time-consuming and fraught with unintended adverse
consequences. Evaluation of these systems following implementation
shows that some do not meet safety standards established in other
industries like the airline and pharmaceutical industries, he
said.
"We are building this huge health information technology system
that we don't know how to monitor properly," Sittig said. "These
electronic interventions can adversely affect patient safety and
quality of care."
Borrowing from the safety practices of other industries, Sittig
and his co-author, David Classen, M.D., associate professor of
medicine at the University of Utah School of Medicine, have created
a five-stage proposal to monitor and evaluate these systems.
- Report electronic health record safety issues - Currently, it
is unclear who a healthcare practitioner would call to report a
problem with an electronic health record system. According to
Sittig, some electronic health record vendors discourage the
release of such information. A reporting system could be created
under the new Patient Safety Organizational Statute utilizing
Agency for Healthcare Research and Quality reporting formats.
- Enhance electronic health record certification - Vendors
developing the software should be required to "demonstrate that
their applications have been designed for safety, developed
correctly, work as designed and had all their defects fixed,"
Sittig said.
- Encourage self assessment of electronic health record use -
Each organization should perform and document an extensive review
of its clinical information systems on a yearly basis. This review
should include hardware and software, clinical content, user
interfaces, user training and authorization procedures, clinical
workflow and communication, organizational policies and procedures,
compliance with state and federal rules and regulations, and
periodic measurements of system activity.
- Conduct unannounced on-site inspections - Sittig and Classen
propose random, on-site inspections by The Joint Commission, a
not-for-profit organization that accredits and certifies healthcare
organizations and programs, or local health departments.
- Implement national electronic health record adverse event
investigation board - Much like the National Transportation Safety
Board investigates accidents, the Office of the National
Coordinator for Health Information Technology could create a board
to investigate electronic health record problems, Sittig said.
"President Obama has taken an important step toward improving
the clinical computing infrastructure of the U.S. healthcare
delivery system by stating the goal of all citizens having access
to an electronic health record. However, the extremely aggressive
timeline in the ARRA stimulus package places enormous pressure on
healthcare practitioners and their organizations to rapidly
implement electronic health records. Such rapid implementations
could lead to significant patient safety events," write Sittig and
Classen in the paper.
SOURCE