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HIMSS: Don't Let HIT Obscure Patient Safety Needs

 |  By cclark@healthleadersmedia.com  
   February 23, 2012

A record number (36,500) of health information technology wizards, CIOs, and other interested parties are flooding Las Vegas this week for an immersive experience at the Healthcare Information and Management Systems Society annual conference, HIMSS12. 

The event is a backdrop to an innovation avalanche that many believe will both improve access to and quality of healthcare, and reduce its cost. 

The miles of exhibits and vendor booths, each touting some form of uniqueness, resemble the endless rows of flashy one-armed bandits we weave through each day. Which ones, if any, will ultimately pay off?

Veterans of this event tell me that the excitement pervading the halls this year is unprecedented. There are electronic health record systems, mobile apps, billing and appointment systems, patient engagement portals, diagnostic decision and care pathway support tools, and scads of other offerings from nearly 1,200 vendors all here to help doctors, hospitals, patients, and payers speak to each other in a language they can all understand. 

Yes, that sentence leaves you breathless, just like I am after a few days of all this.  There is a lot happening here.

Today, Thursday, the Centers for Medicare & Medicaid Services through the Office of the National Coordinator for Health Information Technology, is expected to release its long-awaited proposal for rules governing Meaningful Use Stage 2, even as many providers are filing their last pages of paperwork to receive millions in incentive payments under Stage 1.

Big names on the agenda have been packing in audiences all week, including Twitter co-founder Biz Stone, National Coordinator for Health Information Technology Farzad Mostashari, MD; and the CEOs of the Mayo Clinic, Kaiser Foundation Health Plan, and Intermountain Healthcare.

But against this backdrop of feathers and flourish, one particular speaker's late afternoon talk was sobering, and his points deserve a mention lest they get lost amidst the glitz.

 

HIT's Quality Problem
The speaker was quality thought leader David Classen, MD, associate professor of medicine at the University of Utah, infectious disease specialist, and a member of the committee that wrote the November report from the Institute of Medicine: HIT and Patient Safety: Safer Systems, Better Care

The report listed 10 recommendations for improving patient safety through health IT, and making sure that those systems don't create more safety hazards and calls for the Congress or the U.S. Health and Human Services Secretary to take numerous actions, such as create a Health IT Safety Council as well as a new independent agency to investigate patient "deaths, serious injuries, or potentially unsafe conditions associated with health IT."

Classen appeared to be saying to these tech enthusiasts that even though there's a lot of glitter in the convention halls, HIT itself could be error-prone. Despite their promise of a cooler and better way to deliver care, there is little evidence that health information technology systems to date are actually preventing harmful adverse events, he said.

 

In fact, at least three studies have demonstrated that such systems, even when hospitals invested enormous amounts of money in them, failed to capture a significant number of hospital-acquired conditions such as nosocomial infections.

"These hospitals all had electronic (health) records in place," Classen told his audience. "They all had non-punitive, aggressively promoted reporting systems and still they were missing most of their adverse events."

A big concern, Classen continued, is the lack of and dramatic need for requirements that vendors report safety problems and incidents of harm to some federal agency, something that they and their healthcare provider customers don't do now. That's because of language in vendor contracts that Classen and the IOM report called "hold harmless gag clauses that prevent the sharing of this type of performance information."

"A big part of our report was to change the landscape here so that these adverse experiences could be shared without legal liability for healthcare organizations and that compared user experiences... could be made widely available based on vendor performance." he said.

Another major area that providers and vendors should address is the need for ongoing testing of electronic health systems after they are implemented. 

"This was a big issue for us on the IOM committee because it made us realize that all the testing in the world of vendor products on the shelf probably had very little to do with what was going on with the operation of these systems," Classen explained.

Certification organizations that test these devices only as they are implemented into a healthcare system won't solve the problem, he said.

 

2 Take-Home Messages

Classen explained that members of the IOM committee writing the report came up with two take-home messages:

1. Patient safety remains a huge problem in the U.S. and the number of deaths from adverse events is probably higher than (the 98,000 identified in the 1998 IOM report on patient safety, "To Err is Human."

2. Even in the best of hospitals that have electronic medical records in place, "we still have an awful lot of patient safety problems going on. So clearly I think we thought [that] there is an enormous opportunity going forward to find ways to improve the safety of care for patients with health information technology."

I'm not a gambler. I easily resisted any tug to put money into those one-armed bandits. But I'm glad there are so many people who are willing to stake their creative thinking and investments to find ways to bypass human situations that result in medical error.  I just hope that along the way, these systems don't create pitfalls that the IOM report and Classen are warning us to avoid.

 

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