Friday, July 11, 2014

The Risks Of Health IT Are Coming Up More And More Regularly. Where There Is Smoke There Is Fire!

This appeared a little while ago.

Electronic Health Records: First, Do No Harm?

6/26/2014 09:06 AM
EHRs are commonly promoted as boosting patient safety, but are we all being fooled? InformationWeek Radio investigates.
One of the top stated goals of the federal Meaningful Use program encouraging adoption of electronic health records (EHR) technology is to improve patient safety. But is there really a cause-and-effect relationship between digitizing health records and reducing medical errors? Poorly implemented health information technology can also introduce new errors, whether from scrambled data or confusing user interfaces, sometimes causing harm to flesh-and-blood patients.
This is the issue we will tackle in our InformationWeek Radio show, Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST. My guest for the show will be Scot M. Silverstein, M.D., a consultant and professor in the Drexel University informatics program who researches the shortcomings of EHR software. He also tracks the literature on EHR risks and offers his interpretations on the Health Care Renewal blog, where he posts as InformaticsMD. Silverstein serves as an expert witness in cases involving malfunctioning EHRs or malpractice cases involving the reliability of evidence recorded in EHR systems.
Don't expect a simple answer to the question of whether digitization is making healthcare more or less safe, on balance. "People will say, it's got to be better than paper," Silverstein said, in an interview in advance of the radio show. The inherent superiority of digital data tracking winds up being more an article of faith than a solid argument, he said. After all, digital systems can also make mistakes on a much larger scale than mere humans. He points to a case in 2011 where a glitch in the digital prescription system used at Rhode Island's Lifespan health system caused thousands of patients to receive the wrong form of certain medications, simply because the system dropped a suffix for "long acting."
Health IT may be preventing errors, too. Ideally, a comprehensive digital health record would be indexed and searchable to prevent the sort of errors associated with not knowing a patient's medical history or allergies, with automated alerts to warn of undesirable drug interactions and otherwise prevent medical errors before they can happen. That's the future health IT advocates are working toward.
As an informaticist, Silverstein believes in the potential of health IT but adds, "I've been working really hard to promote the elimination of bad health IT from the marketplace." Meanwhile he takes issue with the categorically inflated claims about the benefits of EHRs, which are often treated as self-evident. In one recent post, he observed that federal health officials essentially had to eat their words when challenged to produce evidence. When the American Association for Physicians and Surgeons filed a Freedom of Information Act request for research supporting claims of the of the lifesaving importance of adopting EHR technology, the response that came back was this: "While our Office of E-Health Standards and Services works to implement the provisions of the [American Recovery and Reinvestment Act], we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives."
Lots more here:
Also we have seen this recently.

It's time to redesign EHRs to improve patient safety

June 26, 2014 | By Marla Durben Hirsch
Providers have been lashing out against subpar electronic health record design for years. They gripe that not only do poorly designed systems impede workflow and cost too much, they also create new patient safety problems and don't share data with other systems to coordinate care, as promised. Still, the industry hasn't done much to address these concerns.
However, maybe now they'll have to. New evidence released this week bolsters what the providers have been saying all along: EHRs, as currently designed, adversely impact patient safety.
First, there's the new study of adverse patient safety events at the Veterans Affairs Department (VA), which operates a voluntary, non-punitive reporting program of such incidents. Three-fourths of the 100 EHR-patient safety issues studied related to design issues. Moreover, a whopping 94 percent of the safety concerns were traced back to just four problems, all of them design flaws, including:
  • Unmet data display needs, such as small print or a "poor fit" between information needs and the clinician's task on hand
  • Problems with software upgrades and modifications, which created configuration errors
  • System-to-system interface problems
  • "Hidden dependencies" within the EHR, such as use of matching algorithms that created errors and delays.
Lots more here:
And here are a whole lot of relevant links:
Related Articles:
There is increasingly concern to work out how best we can address these issues in a systematic way. The first thing to do is to recognise there is a series of problems and complexities that need to be addressed.
I wonder will we see any worthwhile contribution for Australian regulators DoHA and NEHTA. I will wait and watch. We need to be very clear there is both good and bad e-Health and we do need to avoid the latter!

1 comment:

Terry Hannan said...

David, Scot is a frequent insightful contributor to the AMIA site on e-health safety. There are many factors involved in the implementation of HIT with no single answer.
Your posting on this topic strongly advocates a need to "look at what works" in eHealth ~ 30 years. "Learn the lessons" of the past and proceed incrementally with ALL those in the health system participating. [Regenstrief/BIDC/Brigham & Women's/Intermountain Health/ DIOGENE/BAZIS,etc.] We must MEASURE what we do. The safety issues of eHealth have direct significance to the PCEHR and its new proposed variant. [See Coiera and PCEHR safety.] "Pan-eHealth" implementations from the start are guaranteed to fail and more likely to do harm.