In February 2010, Dean Sittig, PhD, co-authored a commentary in the Journal of the American Medical Association that listed five ways to improve the safety of electronic health records.

Sittig, a professor at the University of Texas Health Science Center School of Biomedical Informatics, was pleasantly surprised to see some of those recommendations in a new report from the Institute of Medicine. The institute calls for a mechanism for vendors and health I.T. users to report safety issues, and an independent federally sponsored entity, similar to the National Transportation Safety Board, to investigate adverse incidents.

Those are two of the recommendations nearly two years ago from Sittig and David Classen, M.D., an associate professor of medicine at the University of Utah School of Medicine.

In Sittig's mind, a safety board to investigate adverse HIT incidents and creation of a new Health I.T. Safety Council within an existing standards committee to evaluate criteria for judging the safety of health I.T. are the most important of the IOM's recommendations. He believes the Joint Commission could be the organization to inspect and assess EHRs.

Sittig and Classen also advocate a safety certification program for EHRs that would include measuring and assessing usability. The National Institute of Standards and Technology, he notes, has identified a series of "never events" for HIT systems, such as screens without the patient identifier.

Many other industries follow ISO 9000 standards for how software should be developed and implemented, and that needs to come to health care, Sittig says. "Current EHR implementation is often left up to the customer who often is doing so for the first time. When you do something for the first time, you're bound to make mistakes."

Sittig, Classen and Hardeep Singh, M.D., of Houston VA Health Services within weeks will publish a new paper in the Journal of Patient Safety that will detail an oversight process for EHRs and other health I.T. systems.


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