A new report published in the Journal of Patient Safety advocates creation of an independent national board to monitor and improve the safety of electronic health records. Among other duties, the board would have the power to implement unannounced, randomly scheduled, on-site EHR safety inspections.

In February 2010, Dean Sittig, PhD, of the University of Texas Health Science Center; and David Classen, M.D., of the University of Utah School of Medicine advocated five ways to improve EHR safety in a commentary published in the Journal of the American Medical Association. A recent report from the Institute of Medicine mirrored two recommendations--mandatory reporting of safety issues and a national safety board.

Now, in the Journal of Patient Safety, Hardeep Singh, M.D., of Houston VA Health Services joins Sittig and Classen in a new report detailing an oversight process for EHRs. They note that the increasing scope and complexity of EHRs, combined with aggressive implementation timelines under the meaningful use incentive payments program, can create a potentially hazardous environment. "At present, it is unclear which single agency is responsible for EHR oversight."

An EHR safety oversight program should include mandatory, standards-based reporting of adverse events and near-misses, and data analysis, according to the new report, "Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards." Both reporting and analyzing "should be overseen by a new independent board specifically charged with ensuring safety of EHRs nationally," the authors recommend.

The EHR safety board could be modeled after the National Transportation Safety Board. To support the new national board, institutional EHR safety committees, including a designated EHR patient safety officer, would investigate and report all known safety incidents in an organization and perform routine safety self-assessments.

"Because providers in smaller practices might not have resources for these functions, their respective local health information exchanges, independent physician associations, regional extension centers, quality improvement organizations or accountable care organizations could house the needed technical resources," according to the report. "Many institutions also have existing legal and risk management infrastructure that can be leveraged to perform these functions."

In addition to collecting and analyzing reports, the national EHR safety board could publish recommendations for mitigating risk, such as identified common unsafe conditions for specific EHRs.

The board also would have regulatory functions and could develop new error surveillance methods, validate and oversee EHR self-assessments and on-site safety inspections, and disseminate safety guidelines and benchmarks.

"The board would work closely with EHR certifying organizations (and thus indirectly with EHR vendors) to improve EHR design and implementation, and with other government agencies (such NIST and ONC) to coordinate EHR-related rules and regulations," the co-authors say.

The report is available for purchase here for $35.

 

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