Thursday, February 2, 2012

Institute of Medicine Agrees Health IT Poses Risks to Safety. Here Are Their Recommendations

A CAT scan. Where's that big spleen?
Years ago, the Disease Management Care Blog ordered an abdominal CAT scan for one of its patients. The study was reassuringly normal except for the unexpected - and most likely benign - finding of an enlarged spleen. In the absence of any other worrisome findings, the interpreting radiologist recommended that another CAT scan should be done in six months to make sure it wasn't getting bigger. The patient agreed. The DMCB then fired up the electronic health record (EHR), scheduled the CAT scan order for six months, closed the encounter and moved onto the next patient.

Approximately one year later the patient returned for an appointment. That's when it was discovered that the CAT scan had never been scheduled. The DMCB was later told that the EHR wasn't configured to schedule tests 6 months in advance.*

It's on behalf of patients like this and their physicians that the DMCB welcomes this Institute of Medicine report on Health IT and Patient Safety. It recognizes what most front-line EHR-using physicians have known for years:

"The evidence in the literature about the impact of health information technology (IT) on patient safety, as opposed to quality, is mixed but shows that the challenges... involve people and clinical implementation as much as the technology. The literature describes significant improvements in some aspects of care in health care institutions with mature health IT.  For example, the use of computerized prescribing and bar-coding systems has been shown to improve medication safety. But the generalizability of the literature across the health care system may be limited. While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, little published evidence could be found quantifying the magnitude of the risk." (bolding from the DMCB)

In other words, selective reporting involving best case scenarios fail to account for the reality that the old safety issues of a paper-based system are being displaced by new safety issues of an IT system and, what's worse, we don't know the extent of the problem.

Here are the IOM's (paraphrased) recommendations to Health and Human Services (HHS):

1. HHS, working with the EHR vendors, should develop a health IT surveillance plan.

2. HHS should foster the free exchange of information and address the "legal clauses" in contracts that shift liability from the vendors to the doctors (The AMA has referred to these as "hold harmless" clauses).

3. Data is needed that allows health IT users to publicly compare and share experiences among multiple vendors.

4. "A Health IT Safety Council" that assesses and monitor health IT safety should be established.

5. A public register of all health IT vendors should be established.

6. It's time to specify those processes that reduce risk and make the vendors adopt them.

7. Health IT related deaths, serious injuries and unsafe conditions need to be centrally reported.

8. An independent federal entity should be established that is empowered to any investigate deaths, injuries or unsafe conditions.

9. HHS should report annually on its progress.

10 More cross-disciplinary research is needed to improve the design, testing and use of health IT.

Bravo says the DMCB, bravo!

*many of the facts are changed, but you get the gist

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