ONC guide focuses on adopting EHRs to aid patient safety

Better practices can help organizations reduce errors in using systems, says Andrew Gettinger.

Most of the nation’s healthcare organizations have rushed to implement electronic health records in the last few years, and recent research suggests that the complex technology can be challenging to install and use safely.

In response to growing concerns about the impact of healthcare information technology on patient safety, the Office of the National Coordinator for Health Information Technology has released a guide to help providers safely adopt, implement and use it.

Despite the widespread adoption of HIT by hospitals and physician practices, studies have shown that electronic health records have mixed results in detecting and preventing errors that can lead to adverse events and even death. In fact, poorly implemented, designed and used EHRs “can actually lead to errors associated with health IT,” contends Andrew Gettinger, MD, ONC’s chief medical information officer and executive director of the Office of Clinical Quality and Safety.

Although he contends that many of these errors “tend not to get to the patient,” a 2015 alert issued by The Joint Commission regarding sentinel events—unexpected occurrences of patient death and serious injury—found that EHRs “introduce new kinds of risks into an already complex healthcare environment where both technical and social factors must be considered.” The report suggested that, unless risk-reducing measures are put in place, HIT-related harm will likely increase.

Likewise, a 2015 Institute of Medicine report found diagnostic errors in healthcare are at epidemic proportions, causing serious patient safety concerns, and that EHRs are contributing factor.

“Many healthcare organizations face similar struggles in their initial adoption and implementation of health IT,” states the ONC guide. “The process of selecting and implementing an EHR, training users, and managing workflow changes often pose significant challenges. Along the path to improving healthcare quality and maximizing safety through EHRs, healthcare organizations need to avoid or resolve any unanticipated problems associated with these technologies.”

The guide identifies goals, priorities and recommendations related to health IT, based on studies of adverse event reports and claims.

While the guide acknowledges that a substantial body of evidence now supports the claim that HIT improves the quality and safety of healthcare, it also notes that providers face challenges and need to know where to focus their efforts and which problems to prioritize.

Included in the guide are recommendations from ONC’s previously developed Safety Assurance Factors for EHR Resilience (SAFER) guides, which “reflect the most comprehensive compilation of recommendations available to date and should be the first resource that organizations interested in addressing health IT safety should consult.” It takes organizations through self-assessments and step-by-step considerations as they implement EHRs.

“With health IT, there are literally hundreds of decisions that you make,” notes Gettinger. Of particular concern, he says, are the examples of unintended consequences of health IT that detract from the safety of healthcare or from the use of HIT itself.

Gettinger points to the 2014 misdiagnosis of Thomas Duncan, America’s first Ebola patient, who was initially treated and released by Texas Health Presbyterian Hospital’s emergency department in Dallas, only to return to the hospital’s ED where he was admitted for treatment of Ebola and later died.

“There are opportunities in the configuration of the EHR to make it more effective to prevent some of these diagnostic errors,” he says. Despite the fact that Duncan’s travel from Africa was collected by a nurse as part of the influenza screening process and entered into the EHR, Gettinger says it was not in a place where the attending physician would typically see the information.

“Those decisions have a huge impact on safety,” according to Gettinger, who sees lots of opportunities for providers to improve when it comes to safe EHR use. In particular, he emphasizes that it takes a community to implement health IT safely, from the boardroom down to the actual end users.

“Safe care is created locally by the individuals who carefully consider the challenges at each step and make wise choices in adopting, implementing, and using health IT,” concludes ONC’s guide. “The information provided in this guide will hopefully serve as a starting point for organizations interested in using health IT safely to achieve better care and healthier people.”

A separate recently released ONC report on health IT safety summarizes recent evidence in the field, identifying areas where more research is needed and to encourage the development/refinement of existing tools/interventions to increase the safe use of health IT.

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