- Widespread EHR adoption and the short-term impacts of meaningful use are measurably improving patient safety, the Office of the National Coordinator says in a new issue brief. Despite ongoing concerns about transcription errors and poor EHR data integrity that may put patients at risk for medication mistakes and other adverse care coordination events, health IT has done more good than harm over the past decade and a half, say Andrew Gettinger, MD, Chief Medical Information Officer and Acting Director of the ONC’s Office of Clinical Quality and Safety and Senior Policy Analyst Kathy Kenyon, JD, in a Health IT Buzz blog post.
Since the landmark To Err is Human patient safety report published by the Institute of Medicine in 2000, providers and rulemakers have been deeply concerned that health IT could produce more problems than it solves. The EHR Incentive Programs moved forward a decade later with little hard evidence about how computer-based workflows and automated, data-driven analytics systems would impact critical patient care concerns, Gettinger says, but the body of knowledge has grown considerably over the past six years - with generally positive results.
“It’s useful to recall that in 2000 the IOM promoted health IT as part of ‘redesigned systems of care.’ The IOM found that the large number of avoidable deaths identified inTo Err is Human could not be decreased by trying harder in the same old (paper-based) healthcare system,” the blog post says.
“The IOM explained, ‘Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.’”
The indsutry has been working hard since then to achieve its patient safety goals, and the efforts are already paying off. A December 2014 announcement by the Department of Health and Human Services stated that these new approaches to health IT and innovative payment structures that promote accountable care have raised patient safety and hospital quality rates by nearly 20 percent in just three years, saving the healthcare system $12 billion and preventing more than 50,000 fewer patient deaths.
Citing a series of four major systematic reviews of health IT and its effect on patient safety, conducted between 2006 and 2014, the ONC brief points out that one 2006 study found common data-driven technologies such as clinical decision support, EHRs, and computerized provider order entry (CPOE) are linked with better adherence to evidence-based protocols, decreased rates of medication errors, and better capacity to monitor diseases and conditions while making smarter decisions about the utilization of care.
Another study from 2011 that reviewed available literature on health IT and patient safety found that two-thirds of published papers showed “uniformly positive outcomes” resulting from the implementation and use of EHR technology, and another 30 percent professed more positive impacts than negative ones.
The most recent report, published in 2014, looked more closely at meaningful use as a driver of patient safety improvements. “Across the three key areas reviewed (quality outcomes, safety, and efficiency), the authors identified positive results in more than three-quarters of studies,” the issue brief explains.
“[Jones et al.] firmly suggested that future needs are for research on ‘the mediating effects of contextual and implementation factors’ and asserted that ‘study questions, research methods, and reporting of study details have not sufficiently adapted to meet the needs of clinicians, health care administrators, and health policymakers.’”
Despite the need to tailor continued research methods to the rapid evolution of technologies used by healthcare organizations, literature on patient safety generally gives health IT a passing grade. To keep the trend moving upward, providers, developers, and other key stakeholders must continue to refine health IT products and services to help ensure that patients and their safety remain paramount. Research and case studies on emerging areas of concern such as health data interoperability will be needed in order to add to the pool of available evidence as the industry works to reduce harmful unintentional consequences of the ongoing health IT adoption process.
“Health IT is not and never will be a ‘silver bullet’ that reduces unsafe conditions, errors, and adverse events,” Gettinger and Kenyon conclude. “To improve safety and quality, health IT is an important part of delivery system reform and redesigned systems of care. Health IT, when well designed and implemented, is a tool that can help health information flow in ways that allow for improvements in patient health and safety.
“Whatever the drawbacks to health IT systems, the evidence suggests that health IT has raised the floor on safety. At ONC, we are committed to working with clinicians, health care organizations, and health IT developers who share a commitment to making care safer and better by continuously improving the safety and safe use of health IT.”
“It is good to know that the evidence, so far, suggests that the IOM was right back in 2000. We should be going down this path. The widespread adoption of health IT has been a clear benefit to patient safety. We need to continue to work on making health IT even better in a redesigned health system with patient safety and quality its first priority.”