Wednesday, August 03, 2011

Some Useful Pointers on Health IT Errors. What Does This Mean For the PCEHR?

A very interesting article on an article in the Archives of Internal Medicine appeared a few days ago.

Researchers propose method for counting health IT errors

By Joseph Conn

Posted: July 25, 2011 - 6:00 pm ET

A pair of Texas informatics researchers has come up with a classification scheme for categorizing—and ultimately counting—errors involving health information technology.

Their proposal is outlined in a four-page article, "Defining Health Information Technology-Related Errors: New Developments Since 'To Err is Human'" that appears in the July 15 issue of the Archives of Internal Medicine. It references the totemic 1999 study on medical errors, "To Err is Human," by the Institute of Medicine.

The authors of the article are Dean Sittig, a professor in biomedical informatics at the University of Texas Health Science Center, Houston; and Dr. Hardeep Singh, an assistant professor of medicine at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, and Baylor College of Medicine. Sittig is an adjunct associate professor at the Baylor College of Medicine and the founding editor of The Informatics Review, the electronic journal of the Association of Medical Directors of Information Systems. Singh also serves as the chief of the health policy and quality program at the Houston VA's Health Services Research and Development Center of Excellence.

Sittig, in a telephone interview, said the idea for the classification scheme came after he testified about IT-related errors before an IOM panel in December. A fellow witness also spoke about medication errors. Afterward, Sittig said he was approached by an IOM person who asked whether a definition existed for EHR errors. "We decided there really wasn't any," Sittig said, which led to their research and this report.

"There are a lot of people who don't seem to understand when their EHR is responsible for something that happens," he said. "This is what we think constitutes an electronic health-record system error. By creating this definition, people can start to realize we have a problem. We're trying to heighten people's awareness of these things so they come to mind when it happens."

First, Sittig and Singh report as established fact that health IT-linked errors are real, citing 19 types of actual errors—many gleaned from their literature search and others from the authors' own knowledge. The error types are listed in a table that also presents a "sociotechnical model" for health IT evaluation and use that provides "an origin-specific typology for HIT errors."

There is more found here:

There is also coverage here:

How Health IT-Related Errors Hurt Patient Safety

New analysis explains how the occasional glitches with EHRs and related systems can get out of hand.

By Ken Terry, InformationWeek

July 26, 2011


As an Institute of Medicine (IOM) committee considers how medical errors related to health IT affect patient safety, a new analysis published in the Archives of Internal Medicine defines these errors, breaks down their "sociotechnical" sources, and suggests some fixes.

"These errors, or the decisions that result from them, significantly increase the risks of adverse events and patient harm," write Dean Sittig and Hardeep Singh in the Archives article. The reason, they explain, is that "there are often latent errors that occur at the 'blunt end' of the health care system, potentially affecting large numbers of patients if not corrected."

In an interview with InformationWeek Healthcare, Sittig, a professor at the University of Texas Health Sciences Center in Houston, explained that problems in a health information system are usually caught fairly soon. But, because they may affect an entire hospital or a multi-hospital system, they can cause a lot of harm in a short time, he said.

Here is the formal abstract from the Archives


Defining Health Information Technology–Related Errors

New Developments Since To Err Is Human

Dean F. Sittig, PhD; Hardeep Singh, MD, MPH

Arch Intern Med. 2011;171(14):1281-1284. doi:10.1001/archinternmed.2011.327

Despite the promise of health information technology (HIT), recent literature has revealed possible safety hazards associated with its use. The Office of the National Coordinator for HIT recently sponsored an Institute of Medicine committee to synthesize evidence and experience from the field on how HIT affects patient safety. To lay the groundwork for defining, measuring, and analyzing HIT-related safety hazards, we propose that HIT-related error occurs anytime HIT is unavailable for use, malfunctions during use, is used incorrectly by someone, or when HIT interacts with another system component incorrectly, resulting in data being lost or incorrectly entered, displayed, or transmitted. These errors, or the decisions that result from them, significantly increase the risk of adverse events and patient harm. We describe how a sociotechnical approach can be used to understand the complex origins of HIT errors, which may have roots in rapidly evolving technological, professional, organizational, and policy initiatives.

This can be found here:

If you have access via an academic library or CIAP the full text is available from this link.

The last paragraph of the conclusion really says it all.

“In conclusion, rapid advances in HIT development, implementation, and regulation have complicated the landscape of HIT-related safety issues. Erroneous or missing data and the decisions based on them increase the risk of an adverse event and unnecessary costs. Because these errors can and frequently do occur after implementation, simply increasing oversight of HIT vendors' development processes will not address all HIT-related errors. Comprehensive efforts to reduce HIT errors must start with clear definitions and an origin-focused understanding of HIT errors that addresses important sociotechnical aspects of HIT use and implementation. To this end, we provide herein a much needed foundation for coordinating safety initiatives of HIT designers, developers, implementers, users, and policy makers, who must continue to work together to achieve a high-reliability HIT work system for safe patient care.”

It seems to me the bar has been dramatically raised on our expectations of what Health IT can deliver and how well designed and delivered it must be.

Those rushing to deliver the PCEHR should understand - they have been warned that doing what they are attempting is a great deal harder than it might initially appear. It also seems likely that pretty much no-one has got it fully right - or even close - just yet!


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