Health IT’s impact on patient safety continues to be under the microscope and a focus for healthcare organizations. The government has studied and reported on it, professional organizations have acknowledged and weighed in on it, private sector institutions have implemented various levels of it, but a standard approach that is evidence based remains elusive.
The November 2011 IOM report, IT and Patient Safety: Building Safer Systems for Better Care, offers 10 recommendations for improvement that rely on both public and private entities stepping up efforts to make reporting of errors an acceptable practice without repercussions. It calls for expanded funding by AHRQ, ONC and the National Library of Medicine for further research, training, and education of safe practices for the design, implementation and usability of EHRs. More importantly, it calls for more research in the area of patient safety as it relates to the use of clinical systems. And while the published data clearly indicates we don’t yet have a handle on the severity, types and volume of the various safety issues that currently exist, there is clear evidence that there are serious unintended consequences that occur as a result of poor system design, implementation and adoption.
At this juncture in the evolution of implementing safe systems, a think globally, act locally approach is needed. As part of your approach to EHR optimization, it’s important to have a clear safety focus and a designated leader who is responsible for executing an EHR safety strategy. Responsibilities should include evaluating your system using evidence-based tools currently available. Three of these include:
1. NIST’s Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records
2. CPOE Configuration to Reduce Medication Errors
3. AHRQ’s Guide to Reducing Unintended Consequences of Electronic Health Records
Your safety strategy should also include dedicated resources to safety efforts throughout the lifecycle of the system. Building an alliance between your Quality/Risk Management Department and your informatics team is imperative to ensuring these efforts are addressed and risks mitigated. Every unintended consequence that occurs should be reported and evaluated for its actual and potential safety impact as well as the root cause of the event.
AHRQ’s Health IT Hazard Manager will soon be available for standardized documentation and reporting of health IT safety events. Without strong adoption of standardized safety tools and alerts, the likelihood of a safety event occurring is increased. Revisit your adoption strategy and consider implementing the recommendations outlined in the recently published HIMSS publication A Guide to EHR Adoption: Implementation Through Organizational Transformation.
It’s also important to make sure there is a strong communication process in place with front line staff to report any real or potential unintended consequences. Finally, maintain open communication with your EHR vendor to provide feedback on usability improvements. The journey to health IT safety is evolving and will be for years to come as we learn from one another and share our successes and failures — join us.
This article originally published on the HIMSS.org News page.
