Health IT Patient Safety

July 23, 2013

It happened to “Octomom,” Nadya Suleman. Next, George Clooney and Britney Spears.  Most recently, it has allegedly happened to Kim Kardashian following the birth of her daughter in June.  Across the country, medical records are being inappropriately accessed.  In Kardashian’s case, six hospital workers were fired over privacy breaches involving patient records from Cedars Sinai hospital.  However, the perplexing truth is that while simply viewing medical records inappropriately is an unlawful act with harmful repercussions, many may argue that this type of occurrence does not compare to the potentially fatal consequences to patient safety that can transpire when information is inaccurately entered or EMRs fail to display properly.  The widespread adoption of electronic medical records has brought forth countless advantages to healthcare.  However, because of the accessibility and computing features EMRs offer, it is likely that we will see many issues surrounding patient safety in the future.

What are the major security issues and what is the current state of health IT safety?  Let’s examine.

EHR Safety Concerns
Bill Marella, program director for the Pennsylvania Patient Safety Authority, was quoted in Healthcare IT News saying, “When most people talk about the safety of health IT, they’re thinking of software bugs, hardware failures, or network problems. But our data show issues that are much more about the human-computer interface or the ways healthcare providers interact with the technology.  While electronic health records will be the source of many improvements in the long run, in the short run it’s clear they are not a panacea for patient safety problems.” This statement comes after the Pennsylvania Patient Safety Authority published one of the largest summaries of safety issues related to EHRs in Pennsylvania healthcare facilities in 2012.  This compilation was widely cited in the health IT industry for its examination into EHR events.

The report showed that of the 3,099 EHR-related events analyzed by the Authority, 2,763 (89 percent) were reported as “event, no harm,” which meant an error occurred but there no harm to the patient followed. Ten percent of the reports (320) were reported as “unsafe conditions,” which also did not result in a harmful event. Fifteen reports involved temporary harm to the patient due to the one of the following: entering the wrong medication, ignoring a documented allergy, failure to enter lab tests and failure to document.

Marella noted that many EHR errors stem from wrong input including transposition or transcription errors, entering the wrong patient parameters (exp. weight) that create calculations of incorrect therapy, or surprisingly, event the entry of the wrong physician name which can mean reports are sent to the wrong recipient.  A separate study conducted  in 2012 by the ECRI Institute PSO, a patient safety organization that works with healthcare organizations to analyze and prevent adverse events was cited in American Medical News and offered some staggering results.

The study found that of 171 health IT related problems reported during a nine week period, eight incidents resulted in patient harm and three may have resulted in deaths.  The top cause of problems was general malfunctions (29% of incidents).  This could include systems not allowing healthcare providers to enter in the proper information in instruction fields or medication label scanning issues.  Twenty-five percent of problems stemmed from data output issues, such as retrieving the wrong patient record which can lead to wrong procedures or medications ordered.  Twenty-four percent of the issues were data input problems.  For example, typing in the wrong patient identification number which can also lead to wrong procedures or medications ordered.  The remaining issues were mainly data transfer issues.  In one of these cases, a physician’s order to stop anticoagulant medication did not properly transfer to the pharmacy system and the patient received eight extra doses of the medication before the issue was recognized and stopped.

The list of problems stemming from EHRs is unfortunately vast.  One of the main issues with issues in general is that they are often not reported.  Health IT leaders note how important it is to identify incidents as they happen and make patient safety a priority despite how quickly EHRs are growing and advancing.

Health IT Safety   
Just recently, the U.S. Department of Health and Human Services/ Office of he National Coordinator for Health IT (ONC)  released a health IT safety plan aimed at eliminating medical errors and better protect patients.  Fierce Health IT offers a summary of the reports planned actions, which are:

  • Learn– Make it easier to report patient safety events and risks from using EHRs, collect and analyze patient safety events data, and incorporate H.I.T. safety in surveillance of EHRs.
  • Improve– Advance health IT patient safety priorities with the help of Meaningful Use and the National Quality Strategy, add safety into certification criteria for health IT products, investigate issues and rectify problems as necessary.
  • Lead– Encourage shared responsibility for health IT patient safety (including the private-sector), develop a strategy and recommendations for a risk-based regulatory framework for health IT, and establish an ONC Safety program to spearhead the implementation of the safety plan.

In addition to the plan itself, the ONC has contracted with the Joint Commission to identify ways to establish resources and take corrective actions to improve safety.  The Centers for Medicare and Medicaid Services will also be involved.  The organization will promote the use of standardized reporting forms in hospital incident reporting systems and provide training to key personnel on how to identify safe and unsafe health IT practices.

Currently, the Health IT Safety Plan is what is driving patient safety initiatives in healthcare facilities across the country.  The plan has been received well within the industry and hopefully will spur collaboration between EHR software companies, healthcare providers, and government entities to eliminate errors and encourage trust in electronic records from the patient perspective.

Excite Health Partners
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