As We Leap Into The Unknown and Untested We Need To Be Very Careful! People May Die Otherwise!

This article appeared a day or so ago.

New Report Echoes Call for National EHR Safety Board

Joseph Goedert

HDM Breaking News, November 21, 2011

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.

.....

The report is available for purchase here for $35.

More here:
http://www.healthdatamanagement.com/news/ehr-electronic-health-records-safety-reporting-43640-1.html
The issue I believe we have here is that we a purporting to be going live with a PCEHR system just 8 months from now and having apparently done none of the things you need to assure any sense of genuine patient safety.

For reasons that utterly elude me we are running these multiple pilots of various parts of a conceptual system (the Wave 1 and 2 Sites) and then expecting that when those components that are working are somehow ‘fused’ into the PCEHR all will be well, it will all hang together seamlessly and Bob will be our uncle! All I can say is dream on!

It just won’t happen and to be doing this at a national level without some testing at a (small) regional level of the whole system is as Sir Humphrey would put it ‘courageous’!

Consider for a moment the risks associated with one minute aspect of the proposed system - the Consolidated View.

Here a whole range of information from diverse sources is planned to be assembled onto a single screen.

The number of ways all this could go wrong is frankly terrifying (think wrong data, old data, lost data etc., etc.). At the very least there needs to be robust testing and validation of not only the information flows but also the information quality. Even if you get that close to right you then have the issue of this view being intended to be used by both clinicians (who won’t be well trained) and consumers who will essentially be untrained. Where is the evidence that consumers will understand and then sensibly use whatever is provided for them on this screen? Answer it does not exist!

If ever there was a time to get into place mechanisms to properly analyse the utility and safety of the PCEHR System proposals in the hands of consumers (as well as clinicians) it is now.

Consider the apparently simple issue of displaying pathology results. Where is the research that demonstrates the ideal to present such information to consumers and is the same approach optimal for clinicians? Someone might let me know if it exists but we all know it doesn’t. Equally is the PCEHR Consolidated View going to be static no matter who is the user, or will it dynamically re-configure depending on user capability. I wonder who has researched how that is best addressed?

To not have answers to all this, and to not fully pilot a complete implementation at small scale for utility and safety, before batting on because of political deadlines is the height of incompetence and stupidity in my view. Not only are lives potentially at risk but so also is the whole viability of e-Health as a publicly acceptable idea.

Part of the non-existent governance mechanisms has the be a Safety Board to review what is happening on behalf of both consumers and clinicians an to have the power and responsibility to call time out when real risk is identified until it is properly and fully addressed.

The madness of all this just seems to roll on towards an inevitable and very sad outcome.

David.