Diagnostic Errors Fuel Health IT Safety Concerns
With last week’s highly publicized Institute of Medicine report shining a light on electronic health records and the widespread problem of diagnostic errors, industry observers are hoping that Congress will reconsider funding a Health IT Safety Center that lawmakers have heretofore opposed.
The IOM report specifically called out EHRs for their contributing role in causing diagnostic errors, and provided health IT-related recommendations to improve the diagnosis process. While HIT has improved healthcare and patient safety, the technology “can also get ahead of our knowledge of how to use it,” argues Paul Epner, executive vice president of the Society to Improve Diagnosis in Medicine. “We still have to learn how to use all these tools,” according to Epner.
“Clinicians spend more time with the computer than talking to patients,” warns Hardeep Singh, M.D., a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine. In particular, Singh expresses his concern that providers are “rushing through patient visits and quickly entering data into EHRs, with hardly having time to talk to patients about what their history is and what their physical exam looks like.”
Dean Sittig, professor at the University of Texas School of Biomedical Informatics and a specialist on the safety of EHRs, asserts that a Health IT Safety Center—proposed last year by the Office of the National Coordinator for Health Information Technology in a report to Congress—would go a long way to helping reduce HIT-related adverse events and medical errors.
In fact, the center was among the recommendations of a 2012 IOM report on health IT and patient safety which called for the establishment of an independent federal entity for monitoring and analyzing patient safety data and investigating serious incidents related to HIT. However, the center—recently renamed a “Safety Collaboratory” by ONC—has been denied funding by Congress after being requested in fiscal year 2015 and 2016 budget requests from the Department of Health and Human Services.
Andrew Gettinger, M.D., ONC’s chief medical information officer and acting director of the Office of Clinical Quality and Safety, says the Safety Collaboratory is envisioned as a “safe, voluntary, non-regulatory, non-punitive environment for all the stakeholders who work in this space to come together and really examine the evidence and understand how things could be made better.” Gettinger emphasizes that it must be a “safe place where various stakeholders are comfortable sharing the things that they recognize have been issues or problems and what they’ve done to solve them, so other stakeholders can learn from them.” He adds that diagnostic errors are “probably one of the areas that will be focused on by the collaboratory when it’s appropriately funded and underway.”
Sittig is a strong proponent of the Safety Collaboratory, which he argues could leverage its unique position to work with key administrative and policy stakeholders, healthcare organizations, and EHR vendors to achieve four goals: facilitate creation of a nationwide post-marketing surveillance system to monitor health IT-related safety events; develop methods and governance structures to support investigation of major HIT-related safety events; create the infrastructure and methods needed to carry out random assessments of HIT-related safety; and advocate for HIT safety with government and private entities.
“The EHRs need to have more oversight. They can be a lot safer,” says Sittig, who acknowledges that the technology has both benefits and unintended consequences and as a result the industry can expect to see more serious HIT-related safety events. “We can do a lot more to improve the safety of healthcare. This is the time to press ahead so we can get the benefits that are out there to be had. A safety center is an obvious place to do this kind of work.”
Asked if Congress might reconsider funding a Health IT Safety Center, Gettinger offers that legislators “want to do the right thing and identify methods for improving the safety of the general public relative to healthcare” but he opines that in their decision making there has not been a “careful review” of what’s been proposed to date. However, he predicts that when Congress looks at the latest proposal for a Safety Collaboratory “they will start to think about this in a very positive way.”
With a price tag of $17.8 -$20.6 million over five years, Gettinger believes the cost of getting the collaboratory up and running is a “relatively small expenditure for safety, which seems appropriate,” compared to overall spending on healthcare and health IT.