Thursday, February 14, 2013

Interesting Review Of Health IT Safety Events. These Are The Areas We Need To Focus On.

These reports appeared a little while ago.

ECRI analysis reveals HIT problems

By Bernie Monegain, Editor
Created 02/07/2013
Data transfer, data entry, system configurations and more are identified as serious problem areas for healthcare IT in a new report by ECRI Institute, a patient safety organization.
Concerned about the unintended consequences of HIT and the potential for errors to cause patient harm, ECRI Institute Patient Safety Organization (PSO) recently conducted what it calls a “PSO Deep Dive” analysis on HIT-related safety events. The organization’s 48-page report identified five potential problem areas.
"Minimizing the unintended consequences of HIT systems and maximizing the potential of HIT to improve patient safety should be an ongoing focus of every healthcare organization," Karen P. Zimmer, MD, medical director, ECRI Institute PSO, said in a news release.
Based on reports submitted to the PSO from participating organizations, ECRI Institute PSO identified the following key HIT-related problems:
  • Inadequate data transfer from one HIT system to another
  • Data entry in the wrong patient record
  • Incorrect data entry in the patient record
  • Failure of the HIT system to function as intended
  • Configuration of the system in a way that can lead to mistakes
More here:
There is also coverage here:

Data transfer issues for HIT systems a major safety concern

February 7, 2013 | By Dan Bowman
Data transfer between health IT systems often is inadequate from a patient-safety perspective, according to a new analysis of HIT-related safety events by the ECRI Institute Patient Safety Organization.
In its report, for which 171 health IT events were examined at 36 facilities between April and June of last year, the Plymouth Meeting, Pa., nonprofit organization identified five potential problem areas for such events. In addition to inadequate data transfer, researchers said that other notable health IT related problems included systems not functioning as intended; poor system configurations; inaccurate data entry in patient records; and data entry in the wrong patient records.
"Health IT's promise for improved patient safety and healthcare delivery is great, but so too are its risks of jeopardizing patient safety and care if organizations fail to address, throughout the life cycle of any health IT project, the issues raised by this Deep Dive report," the authors wrote. "As healthcare facilities respond to government incentives to adopt health IT, they must also keep their attention focused on how systems affect safety to ensure that the benefits of health IT can be realized."
A breakdown of the events found that more than half (53 percent) were associated with medication management systems. Of the systems identified in such events, computerized physician order entry systems were mentioned the most (25 percent of the time). Clinical documentation systems also were implicated in a good portion (17 percent) of such events.
More (with links) here:
This is definitely a report to be carefully reviewed by all involved in Health IT.
David.

15 comments:

Enrico Coiera said...

Both these new and important US studies used the IT incident classification system we developed here in Australia - so we should all feel very proud to see Australian Informatics research being adopted internationally.

If you are interested, the three IT incident papers that these two US incident studies are in part based upon can be found here:

1/ http://jamia.bmjjournals.com/content/17/6/663.full

2/ http://jamia.bmjjournals.com/content/19/1/45.full

3/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243129/

I make no comment upon our local uptake! We will be reporting some new work on e-health safety in the journals over the next few months, so watch this fast moving area of informatics research and practice.

Bernard Robertson-Dunn said...

There is a report in iTNews today
NEHTA shrugs off health records patent threat
http://www.itnews.com.au/News/333167,nehta-shrugs-off-health-records-patent-threat.aspx

Apart from NEHTA shrugging off the patent issue, which is probably a reasonable attitude for a bureaucrat to take at the moment - it all seems hearsay, there is an interesting fact buried in the report.

The system has just 56,761 users to date.

There is also a statement that "Rosemary Huxtable, Deputy Secretary of the Department of Health and Ageing nonetheless remained steadfast that PCEHR would meet its nationwide 500,000 target by the end of June."

I wondered just how realistic this is. So, as someone who builds models professionally, I thought I'd have a look at a few numbers.

The government expects to have 500,00 registrations by the end of June 2013
That is an average of 41,667 per month for this financial year.

Assuming the 56,761 registrations is at 1 Feb 2013, that is an actual average uptake of 9,460 per month.

Or, they have registered in 7 months just over the one month expected average

And also means that they need to register 443,239 before the end of June.
That's 88,648 per month, average for five months.

11 times the average of the first seven months.

But wait, there's more.

The budget papers for 2012-1013 estimated a million registrations in 2013-2014.
That's an average of 83,333 per month. Assuming a linear growth in average monthly registration in 2013-2014, they were expecting to achieve this 83,333 average in December/January 2013-2014, i.e. in about 18 months time

So DoHA is hopeful that the average registration for the next five months will be greater than they were predicting it would be in 18 months time. And currently it is running at about one ninth of that figure.

I'll leave it up to you to answer the question: Is this realistic?

And I'll ask one of my own. Do you think that Rosemary Huxtable is being properly advised?

Anonymous said...

Rosemary Huxtable needs to spend far less time "spinning" and far more time "thinking" and coming clean with Australian taxpayers.

It's not about any advice she may be receiving!

So it's odds on the PCEHR won't make it's 12-month target. It's also odds on "nothing" will occur and noone will be held accountable as per the national eHealth historical record, and Ms. Huxtable and Ms. Halton know this all too well.

And this is the crime being perpetuated against the Australian taxpayer and Australian healthcare system patients!

Keith said...

Rosemary Huxtable seems to think that now that most software vendors have PCEHR-compatible versions on offer that the last hurdle to widespread uptake has been removed. Not so. First, practices have to install the software; some have been reluctant because of performance and reliability issues. Second, practices need "NASH" certificates. DHS seems to be struggling to meet the demand judging by the long delays we are experiencing. (Maybe we do need that $24M NASH system after all?) Third, GPs have to be convinced to put time and effort into creating patient summaries.

Finally there is a "critical mass" problem which seems to have received little attention: if, say 20% of all GPs are PCEHR registered, and 20% of all patients have created a PCEHR, it is only about 4% who satisfy both criteria and can thus get a health summary uploaded to their PCEHR. Until most GPs are registered this will continue to ba a limiting factor.

Anonymous said...

It will be good when we can get discharge summaries from hospitals and health services in. I think that will encourage more registrations from consumers and from doctors. That might get the numbers up a bit.

Anonymous said...

"It will be good when we can get discharge summaries from hospitals and health services in. I think that will encourage more registrations from consumers and from doctors. That might get the numbers up a bit."

Tell him he's dreamin'!

Anonymous said...

He's dreamin alright and I think he must believe in fairies too.

There is a report in News Limited press today: "Doctors Shun e-health records scheme". Less than 1 per cent of the nation's health practitioners have signed up to the $1 billion e-health scheme.....

and the bit that's most amusing

"One GP told News Limited he crashed the entire computer system for his practice when he tried to upload just one e-health record."

Now that will really encourage people to join up in droves won't it!

Anonymous said...

Why would you assume a linear growth model, Bernard? Wouldn't a Bass Diffusion model be more appropriate (S shaped)? See http://insightmaker.com/insight/610 and related models

Anonymous said...

All our rural practice is interested in is ETP. We have 20 doctors and at present all bar two routinely use the ETP facility. Most of the pharmacies in our area are connected and its working well. Some of our patients want access to see their medicines record which is not yet available but we have bee told it will be soon. No complaints so far.

Bernard Robertson-Dunn said...

re: "Why would you assume a linear growth model, Bernard?"

Because I'm only doing a back of the envelop model. I reasoned that it is unrealistic to expect the average registration rate to be flat for the whole year. A symmetrical, linear growth rate puts the average rate at about the six month point.

Using something more complex, but probably more accurate, involves many more assumptions such the start and end points of the S curve. My gut feeling is that it is only likely to push the point at which the annual average is achieved later on in the year.

For the purposes of answering the question "is Rosemary Huxtable's prediction realistic?" it doesn't really matter if next year's average is achieved in any specific month. A range of End-of-December plus or minus two months is probably going to lead to the same conclusion.

Bernard Robertson-Dunn said...

I shouldn't trust press reports.

What I said here is a load of rubbish:


The budget papers for 2012-1013 estimated a million registrations in 2013-2014.
That's an average of 83,333 per month. Assuming a linear growth in average monthly registration in 2013-2014, they were expecting to achieve this 83,333 average in December/January 2013-2014, i.e. in about 18 months time

So DoHA is hopeful that the average registration for the next five months will be greater than they were predicting it would be in 18 months time. And currently it is running at about one ninth of that figure.


When I looked at the actual budget papers www.health.gov.au/internet/budget/publishing.nsf/content/2012-13_Health_PBS_sup2/%24File/2.10_Outcome_10_(A).docx

It says that in Forward Year 1 (2013-2014) the expected number of registrations is 1.5 million, not 1 million.

That equates to an average registration rate next year of 125,000 per month, way more than Ms Huxtable's expected average for the rest of this year.

If, once again, you assume an linear growth rate next year and a doubling of rate over the year, that would make the numbers 80,000 per month in July 2013, rising to about 170,000 per month by year's end.

So Ms Huxtable is expecting the average rate for the rest of the year (currently running at 9460 per month) to be 88,648. This compares to my expected rate at the start of next financial year of about 80,000.

So the question still remains.

Given that:
Current rate = 9460,
Necessary average rate to achieve 500,000 registrations this year = 88,648.
Average rate next year = 125,000

Are these realistic?

In a report from Pulse+IT it expands on Ms Huxtable's prediction.

"DoHA deputy secretary Rosemary Huxtable said the 500,000 figure was the department's expectation based on international evidence of what it could expect within the first full year of operation."

Based on "international evidence"?? I wonder who came up with that wonderful justification for Australia's expected registration uptake.

And another question: What has been/is the limiting factor on registration rates?

Availability of PCEHR-compatible GP software?

Allocation of HPI-Os and NASH certificates?


Or something else?

Anonymous said...

"DoHA deputy secretary Rosemary Huxtable said the 500,000 figure was the department's expectation based on international evidence of what it could expect within the first full year of operation."

In truth Ms Huxtable is almost right.

Many said several years ago when the PCEHR was first proposed that the international evidence suggested the uptake for a system like the PCEHR would be poor (think the English NHS' failed PHR ), because utility would be low. And lo and behold those "critics" turn out to be right. The "international evidence" suggested it would tank and it has.

Yes by all means, lets look to the international evidence.

Anonymous said...

"What has been/is the limiting factor on registration rates? Availability of PCEHR-compatible GP software?
Allocation of HPI-Os and NASH certificates? Or something else?"

The 500,000 target is for consumer registrations. The numbers are down because it was a very quiet launch. Most people still have no idea it exists.

It's a bit of a catch-22: there is nothing much in the records until the providers can start putting it in, and the providers can't put it in until they participate by implementing conformant software, and the vendors who provide the conformant software could not do that until the integration specifications were finalised, and the specifications were provided to vendors well beyond the original anticipated schedule.

Despite all parties knowing this is the case, the unreal registration targets seem to be based on the assumption that the full set of functionality would be and was available on day 1, together with all providers having implemented conformant software such that they could interact with the core component.

It just doesn't make sense. The targets should have been revised when they realised that functionality would be available in stages. Why don't they just come clean and tell the truth. The public are not stupid and do not want to be treated that way.




Anonymous said...

"The targets should have been revised when they realised that functionality would be available in stages. Why don't they just come clean and tell the truth. The public are not stupid and do not want to be treated that way. "

That moment of realisation was also the moment they should have said

1 - We were wrong

2 - We were poorly advised

3 - We also willfully ignored the evidence and expert advice when we saw it

4 - We apologise

5 - We resign.

Bernard Robertson-Dunn said...

re: "That moment of realisation was also the moment they should have said: .."

Unfortunately, that's not the way governments work.

If a New Policy Proposal (NPP) manages to get through the budget process and gets approved, it takes on a life of its own. Stopping something is harder than starting it.

It's also not the way NPPs and projects work (this is not new or original, just true):

In the beginning was The Plan.
And then came The Assumptions.
And The Plan was without substance.
And The Assumptions were without form.
And darkness was upon the face of the Workers.

And they spoke among themselves, saying,
"It is a crock of s--t, it stinks."

And the workers went unto their Supervisors, and said,
"It is a pail of dung, and none may abide the odour thereof."

And the Supervisors went unto their Managers, saying
"It is a container of excrement, and it is very strong, such that none may abide it."

And the Managers went unto their Directors, saying,
"It is a vessel of fertiliser, and none may abide its strength."

And the Directors spoke among themselves saying one to another,
"It contains that which aids plant growth, and it is very strong."

And the Directors went to the Deputy Secretaries, saying unto them,
"It promotes growth, and it is very powerful."

And the Deputy Secretaries went to the Minister, saying unto her,
"This new plan will actively promote the growth and vigour of the government, with powerful effects."

And the Minister looked upon The Plan, and saw that it was good.
And The Plan became policy.

And that is how S--t happens."