Friday, May 1, 2015

IOM Was Right on Health IT and Patient Safety

The Evidence Shows IOM Was Right on Health IT and Patient Safety


April 27, 2015, 10:00 am / Andrew Gettinger, M.D. / Chief Medical Information Officer, Acting Director, Office of Clinical Quality and Safety , and
Kathy Kenyon, J.D. / Senior Policy Analyst
The potential for health IT to reduce errors has been a pillar of health policy on patient safety since the Institute of Medicine’s To Err is Human(2000) and Crossing the Quality Chasm (2001).  In 2012, in Health IT and Patient Safety: Building Safer Systems for Better Care the IOM found the evidence on the impact of health IT on patient safety was “mixed.”  Since then, whether health IT actually improves patient safety has remained an open question.
The nation has seen widespread adoption of health IT as a result of the Medicare and Medicaid EHR Incentive Programs.  With that increase in adoption, there should be more and better evidence on the actual impact of health IT on safety.  Health IT should raise the floor on patient safety, and the evidence shows that it has.

Institute of Medicine and Health IT in Redesigned Systems of Care
To add perspective, it’s useful to recall that in 2000 the IOM promoted health IT as part of “redesigned systems of care.” The IOM found that the large number of avoidable deaths identified inTo Err is Human could not be decreased by trying harder in the same old (paper-based) healthcare system. The IOM explained, “Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.”
Health IT is not and never will be a “silver bullet” that reduces unsafe conditions, errors, and adverse events. To improve safety and quality, health IT is an important part of delivery system reform and redesigned systems of care. Health IT, when well designed and implemented, is a tool that can help health information flow in ways that allow for improvements in patient health and safety. Whatever the drawbacks to health IT systems, the evidence suggests that health IT has raised the floor on safety. At ONC, we are committed to working with clinicians, health care organizations, and health IT developers who share a commitment to making care safer and better by continuously improving the safety and safe use of health IT.
It is good to know that the evidence, so far, suggests that the IOM was right back in 2000. We should be going down this path. The widespread adoption of health IT has been a clear benefit to patient safety. We need to continue to work on making health IT even better in a redesigned health system with patient safety and quality its first priority.

he Office of the National Coordinator for Health Information Technology (ONC) convenes the first joint meeting of the Health Information Technology Policy and Standards Committees. We intend to spend the day discussing interoperability in the health information ecosystem.
Committee members will hear a final report from the Joint Jason Task Force, an update from the Interoperability Governance Sub-Committee and an interim report from ONC’s Interoperability Portfolio Manager. These presentations mark several months of dedicated work developing a more detailed, shared roadmap to achieve interoperability in this nation, as a means to see that everyone has access to better quality, more affordable care and better health overall.
These conversations follow our release, in June of 2014, of the high-level document Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.  This paper describes ONC’s broad vision and framework to develop a clear pathway towards interoperability. It is intended as an invitation to health IT stakeholders – clinicians, consumers, hospitals, public health, technology developers, payers, researchers, policy makers and many others – to join ONC to develop a defined, shared roadmap that would allow us to collectively achieve health IT interoperability as a core foundational element of a learning health system.

Not withstanding the aforementioned positive findings; the following is a caveat regarding EHR and HIT usage.

Industry Reaction Mixed to Joint Commission's Health IT Warning

A recent Joint Commission sentinel event alert that warned health IT can pose risks to patients has received mixed reaction from stakeholders, Health Data Management reports (Slabodkin, Health Data Management, 4/22).

Background

The alert -- which was issued last month -- stated that EHRs "introduce new kinds of risks into an already complex health care environment where both technical and social factors must be considered."
The alert cited an analysis of event reports received by the Joint Commission showing that between Jan. 1, 2010, and June 30, 2013, hospitals reported 120 health IT-related adverse events. Of those errors:
  • About 33% stemmed from human-computer interface usability problems;
  • 24% stemmed from health IT support communication issues; and
  • 23% stemmed from clinical content-related design or data issues.
The alert recommended:
  • Implementing comprehensive systematic analysis of all adverse events to determine whether they were the result of health IT issues; and
  • Limiting the number of patient records that can be displayed on the same screen at once (iHealthBeat, 4/1).

Study: EHR Systems Lack Adequate Lab Data Graphing Functions

Brookings Report Finds Significant Gaps in EHR Interoperability


Health Information Technology: Where We Stand And Where We Need To

Karen B. DeSalvo, M.D., M.P.H., M.Sc.

Karen DeSalvo, M.D., M.P.H., M.Sc., the National Coordinator for Health Information Technology, discusses her view of the health information technology landscape. She outlines an agenda for her office that includes incentivizing interoperability, “standardizing standards,” and establishing shared expectations and actions around data security and privacy. This post, which also appears on Health Affairs Blog, is based on Dr. DeSalvo’s presentation at the Health Information and Management Systems Society 2015 annual conference last week.

Blocking of health information undermines health system interoperability and delivery reform

April 10, 2015, 7:29 am / Karen B. DeSalvo, M.D., M.P.H., M.Sc.
The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Robert Wood Johnson Foundation releases Data for Health: Learning What Works

April 2, 2015, 12:36 pm / Karen B. DeSalvo, M.D., M.P.H., M.Sc.
The Office of the National Coordinator for Health Information Technology (ONC) is committed to advancing an interoperable learning health system that impacts individual, community and population health. To achieve this goal in the next several years will require collective action from all public and private stakeholders, including consumers and community-based groups outside of what is traditionally considered the expected set of technology and health care entities.

New ONC Grant Funding Opportunities Help Advance Health IT in Communities and Workforce Training

February 3, 2015, 4:47 pm / Karen B. DeSalvo, M.D., M.P.H., M.Sc.
ONC has released a funding opportunity announcement designed to strengthen the health IT workforce and build on work done by the 17 Beacon Communities to innovate health care delivery with the goal of building a learning health system, as outlined in the recently posted Shared Nationwide Interoperability Roadmap. These initiatives are part of the Department of Health and Human Services’ efforts to achieve better care, smarter savings and healthier people.

HHS and ONC invest $28 Million in Health Information Exchange Grants

February 3, 2015, 10:00 am / Karen B. DeSalvo, M.D., M.P.H., M.Sc.
U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell announced this morning an important Office of the National Coordinator for Health Information Technology (ONC) funding opportunity, which is part of a Department-wide effort to achieve the safe and secure exchange and use of electronic health information to improve health and transform care as outlined in the Shared Nationwide Interoperability Roadmap, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0.

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