Monitor EMRs for effect on safety

Even under the best of circumstances, implementing an electronic health record system is difficult, costly, time-consuming, and fraught with unintended adverse consequences, says Dean Sittig, PhD, who presented information to the panel that developed a recent report by the Institute of Medicine (IOM) on the dangers of information technology. Sittig is a professor at The University of Texas Health Science Center at Houston School of Biomedical Informatics and a member of the faculty of The University of Texas — Memorial Hermann Center for Healthcare Quality and Safety.

Evaluation of these systems following implementation shows that some do not meet safety standards established in other industries such as the airline and pharmaceutical industries, he says. "We are building this huge health information technology system that we don't know how to monitor properly," Sittig says. "These electronic interventions can adversely affect patient safety and quality of care."

Borrowing from the safety practices of other industries, Sittig and his colleague David Classen, MD, associate professor of medicine at the University of Utah School of Medicine in Salt Lake City, have created this five-stage proposal to monitor and evaluate these systems.

1. Report electronic health record safety issues.

It is unclear who a healthcare practitioner would call to report a problem with an electronic health record system. According to Sittig, some electronic health record vendors discourage the release of such information. A reporting system could be created under the new Patient Safety Organizational Statute utilizing Agency for Healthcare Research and Quality reporting formats.

2. Enhance electronic health record certification.

Vendors developing the software should be required to "demonstrate that their applications have been designed for safety, developed correctly, work as designed, and had all their defects fixed," Sittig says.

3. Encourage self assessment of electronic health record use.

Each organization should perform and document an extensive review of its clinical information systems on a yearly basis. This review should include hardware and software, clinical content, user interfaces, user training and authorization procedures, clinical workflow and communication, organizational policies and procedures, compliance with state and federal rules and regulations, and periodic measurements of system activity.

4. Conduct unannounced on-site inspections.

Sittig and Classen propose random, on-site inspections by The Joint Commission.

5. Implement a national electronic health record adverse event investigation board.

Much like the National Transportation Safety Board investigates accidents, the Office of the National Coordinator for Health Information Technology could create a board to investigate electronic health record problems, Sittig says.