In the rush to meeting meaningful-use health information technology (HIT) deadlines, a lack of focus on patient safety may have been one of the unintended consequences.
Joseph Schneider, MD, Baylor Health System vice president and chief medical information officer and medical director of clinical informatics, wrote Texas Medical Association’s (TMA) response to the U.S. Health and HIT Patient Safety Action and Surveillance Plan.
Schneider, chairman of TMA’s health information technology committee, wrote: ““TMA believes that significant patient safety risks exist now and new ones will emerge in the next one to two years as many EHR and other HIT vendors merge or go out of business. Therefore, it is imperative to set mandatory deadlines and have a robust reporting and learning system in place now, not later. We are extremely concerned that the proposed plan lacks the specificity necessary for success.”
Schneider estimated there are more than 1,000 electronic health record (EHR) vendors.
“We think the long-term number is going to be about 20 (by the end of the decade). Even if it’s 100, there is going to be a huge fallout of vendors once the federal money stops,” he said.
Schneider said that vendors going out of business mean that changes and fixes are not made for those systems. He said GE has announced it is abandoning one of its ambulatory systems in 2016 and will not be supporting the system after the end of this year.
In a 2011 report, the Institute of Medicine (IOM) said there was little published evidence that quantifies the risk associated with health IT problems, partly because many technology vendors discourage the free exchange of safety-related information in their contracts with health care providers. However, technology errors have led to medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data. The IOM said those problems have led to patient deaths and injuries. It called for an avenue for both technology vendors and users to report health IT-related deaths, injuries, or unsafe conditions. It also urged Congress to establish an independent federal entity to investigate patient deaths, injuries, or potential unsafe conditions associated with health IT.
Other researchers have documented unintended consequences of EHR implementation that create inefficiencies for users and threaten patient safety.
In its response to the HHS plan, the American Medical Association (AMA) wrote there has been too little research regarding the EHR systems in ambulatory care.
“Physicians are concerned about potential liabilities from EHR system design and software flaws as well as lack of interoperability among EHR systems that could result in incomplete or missing information, which may lead to errors in patient diagnosis and treatment. The AMA believes more research is needed in the ambulatory setting to determine and monitor the effects of EHR use on patient safety,” the AMA said.
Schneider said small physician practices and even small hospitals would have difficulty complying with federal regulations and focusing on patient-safety issues.
“They tend to run a pretty lean ship. They don’t have horsepower and often have to rely on the vendor or outside resources. Others rely on regional extension center on consultants, some of whom are great and others are not so great,” he said.
Schneider and TMA also are urging the appointment of a federal HIT safety czar who can promote safety by focusing on the proper implementation steps. He said Farzad Mostashari, MD, head of the Office of the National Coordinator for Health Information Technology is doing “a wonderful job promoting EHR but he is not able on safety issues. He is doing great and superhuman work, but (also focusing on safety is) over and above what one person can do.”
Schneider and TMA also recommend the designation of a single patient safety organization that can serve as a confidential clearinghouse for gathering and analyzing adverse events caused by HIT.
Steve Jacob is editor of D Healthcare Daily and author of Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected].
