Tuesday, July 22, 2014

PCEHR Consultation: Here Is The Sort Of Issue We Need To Make Sure Is Discussed And Addressed!

This appeared a few days ago:

EHR Systems Falling Short in Improving Patient Safety

Greg Slabodkin
JUL 18, 2014 9:21am ET
Health information technology, such as electronic health records, has the potential to dramatically improve patient safety. Nevertheless, a majority of healthcare organizations are not using EHRs to help track adverse events, and ones that are have their own health IT–related safety risks.
“Most hospitals, even those with EHR systems, do not know their own rates of adverse events,” testified Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, on July 17 before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. “They don’t know how often they harm patients. However, there are now tools available that automatically track these events and these tools are generally quite good. Yet, most EHR vendors have not put these tools into their EHR systems.”
Jha argued that if automated patient safety monitoring was made a key part of certification for the EHR meaningful use program, it would have a dramatic effect on the EHR vendor industry. “The EHR products now being built would scan clinical data and provide real-time surveillance information to doctors, nurses, pharmacists and other healthcare providers about potentially bad events that might be happening to patients,” he said. “It would allow hospitals to intervene quickly, and track their own progress over time.”
Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, argues that “the federal government and healthcare organizations have spent hundreds of billions of dollars on health information technology with little to show for it.”
“The promised improvements in safety have not been realized and productivity has decreased rather than increased,” said Pronovost. “Moreover, the usability of most HIT is poor.” For example, to obtain the meaningful use incentives, Johns Hopkins implemented a technology approved by the Office of the National Coordinator for Health IT.
However, he said that shortly after the technology was turned on, clinicians raised concerns that it made care less safe. “After thousands of hours of work, we essentially turned all the supposed ‘safety’ functions for the tool off and had the doctors type the patient’s medications into the tool, allowing us to receive the financial incentives for meaningful use, hurting clinician productivity and failing to improve safety.”
More here:
The link to a very recent RAND report on the topic is here:
Two extracts from the Executive Summary say it all.
The challenges and lessons identified in this pilot project point to several opportunities to  increase the safe use of health IT systems. We draw several conclusions about the current state of  health IT safety risks:
1. With few exceptions, awareness of the safety risks introduced by health IT is limited.
2. The traditional departmental “silos” between risk management, IT, and quality and safety management may impede the ability of organizations to recognize and respond to health IT safety risks.
3. External facilitation appears to be important to hospitals and practices; however, the model for providing consultation and technical assistance requires further elaboration.
4. Most ambulatory practices lack the risk management, IT, and quality and safety expertise that is available in hospitals.
5. There is an urgent need for tools and metrics to enable project teams in hospitals and ambulatory practices to detect, mitigate, and monitor health IT safety risks.
6. The current structure of the EHR marketplace, and the low awareness of the risks introduced by health IT systems, lead to weak incentives for EHR developers and providers to invest in the type of joint effort required to reduce health IT safety risks.
And here:
The investment that is converting the U.S. health data infrastructure into a 21stcentury enterprise has the potential to improve care for patients in countless ways. However, “digitizing” the health system also has the potential for harm. In this project, we worked with 11 hospitals and ambulatory practices to evaluate a process improvement strategy and tools developed to help health care organizations diagnose, monitor, and mitigate health IT–related safety risks. While many of the health care organizations (especially the hospitals) had expertise in process improvement, we found a general lack of awareness of health IT–related safety risks (especially in ambulatory practices) and concluded that better tools are needed to help these organizations use health IT to improve care and to optimize the safety and safe use of EHRs. The SAFER Guides provide an excellent beginning, but until health care organizations have a better understanding of the safety risks posed by EHR use, tools like the SAFER Guides may not be used to their full potential. There may also be a need for additional tools and metrics (and further usability study of existing tools and metrics) to better support the needs of health care organizations as they use health IT to improve the quality and safety of patient care.
---- End extracts (Report is 77 pages)
I raise all this to express a desire that the pathetic non-consultation we saw on the PCEHR does not recur and that we see fundamental issues discussed rather than a discussion of how best to apply the lipstick to the pig.
The PCEHR has largely failed through lack of engagement with relevant stakeholders and a ‘tin ear’ from NEHTA and DoHA as well as a failure of recognition that e-health is a lot harder than they are prepared to admit. Most who read here know a lot better.
If we are not to squander more money and effort other perspectives are crucial. If we don’t have safety definitely sorted how dare anyone plan to move forward?
Put up your hand all those who think we do!


Bernard Robertson-Dunn said...


Looking at the root causes, and repeating myself, the failure of the PCEHR and other health IT is, IMHO, mostly to do with the approach that government takes to such systems. They view them as IT, project management problems.

Everything about the PCEHR has been about technology. The review looked at the design and implementation of an IT system. Safety is just one of the many aspects of health information that has been overlooked and ignored.

IMHO, there will be no meaningful progress in the area of better health care and improved health outcomes until the problem is viewed in terms of 1) health information and 2) decision making, based upon quality and relevant information.

Unfortunately, major changes in approaches and in government mindsets requires one or a few significant catastrophes, and irrefutable evidence that what has been done in the past is no longer appropriate. This will not guarantee that what is done next is the "right thing", but seems to be a necessary condition for change. At the moment all we have is public money being spent on a failed IT system. This is so normal as to attract no special attention.

In some respects, making the system opt-out and used more frequently is likely to highlight the system's failings quicker and bring about the required changes earlier. I just hope that people don't die or get harmed in the process.

Dr Ian Colclough said...


You said "The PCEHR has largely failed through lack of engagement with relevant stakeholders."

I thoroughly agree with you. However, permit me to add that simply engaging with relevant stakeholders is not sufficient.

An imperative here is 'effective leadership' and 'effective communications' and all that that entails. That is sorely lacking.

Bernard rightly observes that major changes in approaches and in government mindsets requires a genuine acknowledgement that what has been done in the past is no longer appropriate. That is the first step.

The next step is to let go of the past and embrace new ways of thinking about the problem to be solved. That will be difficult. Difficult for those who hold the power and control as they will resist change in order to preserve their position and perpetuate the status quo.

Anonymous said...

Ian said...

"Difficult for those who hold the power and control as they will resist change in order to preserve their position and perpetuate the status quo."

... and because of hubris.