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Health IT Patient Safety Center to Tackle EHR, Usability Hazards

By Jennifer Bresnick

- The breakneck pace of EHR adoption and the industry’s sudden reliance on health IT systems to complete the majority of their daily tasks has its positives and negatives.  While technology has enabled providers to engage in predictive analytics, population health management, and computer-assisted clinical decision support that helps them deliver timely, targeted care, health IT has also been blamed for a new crop of patient safety hazards that have serious ramifications for care quality and outcomes. 

Patient safety risks and EHR adoption

Providers and patient safety advocates have voiced their concerns to leaders at the Office of the National Coordinator (ONC) for years, and the ONC has responded with a number of initiatives, frameworks, and guidance opportunities for healthcare organizations feeling overwhelmed by the dangers of hybrid EHR-paper workflows, distracting alerts and alarms, risky workarounds, and data integrity, device integration, and transcription errors that put patients at risk of adverse events.

In a blog post published this week on Health IT Buzz, ONC Chief Medical Information Officer and Acting Director of the Office of Clinical Quality and Safety Andrew Gettinger, MD, unveils the ONC’s latest response to these ongoing concerns: the Health IT Safety Center Roadmap.

“As we focus on making our health care ecosystem interoperable and building a continually improving learning health system, we need to ensure health IT enables safe, high quality care,” Gettinger writes. “We also know that doctors, nurses, and other clinicians that are all part of the care team are frustrated by health IT systems that are not coordinated or optimized to their workflow. Many of these systems will benefit from additional usability review, safety enhanced design and feedback from the user community.”

The establishment of a multi-stakeholder, public-private Health IT Safety Center would help to triage industry concerns about the impact of EHRs and other health IT systems on patient safety, Gettinger says, and the Roadmap represents a collaborative effort to outline how such an organization would function.

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“The Roadmap that was issued today envisioned the Health IT Safety Center as a trusted convenor of public and private stakeholders to create a learning health system for health IT and patient safety,” he writes. “The rationale was that the format envisioned would promote more safety content being disclosed in an environment of collaboration and shared purpose.”

“This work builds on many of the successes that have been achieved in helping to protect patients by organizations and individuals all across the nation. But it also points to some of the steps that need to be taken to respond to new errors that might have been introduced by the use of health IT; adverse events that need to be identified and the circumstances that lead to them addressed.”

The ONC and its partners view the Health IT Safety Center as a “trusted space for collaborating on solutions,” the document states, supported by up to $20.6 million in funding over five years.  The Center would bring together stakeholders from across the care continuum, including patients and caregivers, individual providers and larger healthcare organizations, health IT developers, patient safety organizations, interoperability experts, and a range of health IT professionals, including informaticists, engineers, HIM professionals, and privacy experts, and designers to ensure that any solutions identified by the Center are scalable and easy to implement.

The Center will not perform any regulatory functions, Gettinger says, but will instead act as an advisory and advocacy group, serving as “the leading voice in addressing patient safety generally and health IT-related safety issues more specifically.”

Initially, the Center will focus on four major tasks, which will include bringing stakeholders together to identify problems and collaborate on solutions, improving the process of collecting and reporting on patient safety data, reporting evidence on health IT-related patient safety issues to relevant organizations, and promoting education and best practices around using health IT for the benefit of patients while avoiding the possibility of harm.

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Ultimately, the Center hopes to address the provider community’s most persistent doubts about the value of EHRs and health IT, including the notion that EHR adoption is simply more trouble than it’s worth.  The ONC does not believe that these negative perceptions are incurable, but acknowledges that they are based on real problems that must be remediated before health IT can truly achieve its potential.

“Over the course of the past year an intriguing fact emerged from the literature: Clinicians who were completely frustrated with the electronic health records that they are currently using, if given the opportunity, few said they would return to paper and pen-based records,” Gettinger writes. “Now it is up to all of us who are working for the safe and secure use of health IT to move forward to a place where clinicians are not just satisfied with their work systems but where they couldn’t possibly imagine providing clinical care without them.”

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