With Patient Safety Awareness Week kicking off this past Sunday, I thought it was as appropriate a time as ever to pose the question: “Do electronic health records (EHRs) impact patient safety events?”
The research available is mixed.
Some research indicates that EHRs can improve or prevent patient safety events, some claim they play a contributory role, and still other research indicates EHRs have little-to-no impact on patient safety. “Little published evidence could be found quantifying the magnitude of the risk,” said the Institute of Medicine’s 2011 report, Health IT and Patient Safety Building Safer Systems for Better Care.
Let’s get real.
EHRs can absolutely contribute to patient safety events because the introduction of any new technology in health care can do so.
Yes, technology has improved patient safety in some areas. But in others, it has introduced new areas of risk. As a clinician who spends her days evaluating reports from EHR users and developers about potential patient safety risks, it’s indisputable that EHRs play a role.
But the truth is that no vendor is willing to risk their stock price on sharing data that details how they may have played a contributory role or could have prevented an issue. Don’t some of the richest learnings come from a study of our mistakes and failures? Can’t we have an open and truly honest dialogue about what happens behind the curtains so that we can improve outcomes and protect patients?
We believe so. And we’ll go first…
Here at athenahealth, we have a patient safety team comprised of MDs, PAs, RNs, software developers, process innovators, usability researchers and usability designers, who all focus on the prevention and remediation of potential patient safety events. These reports come directly from our customers and athenistas.
In evaluating those reports we have learned a number of things that can cause issues:
- Software bugs. The code can cause a potential risk.
- Unsupported workflows. Clients trained on how to interact with the system sometimes deviate from standard workflows, resulting in potential patient safety issues.
- Sub-optimal application design.
- A combination of all three of the above.
Our learnings support the notion of a shared responsibility for patient safety. We take our role in that ecosystem very seriously.
I am confident that athenahealth is not alone in having potential patient safety issues within its applications. It simply comes with being a company that continually innovates, updates and iterates – and any vendor who suggests they’re not in this boat is fooling themselves. What makes us unique is our transparency with the industry and our customers.
Our cloud-based platform provides us the visibility that can assist in the diagnosis and impact of any particular issue. When Surescripts issued an alert on February 18th to all EHR vendors in its network to communicate a potential inaccuracy in medication information, we were able to run a report across our entire customer base to identify exactly who was impacted. We could identify the individual patients within each practice who had inaccuracies in a specific medication entry within their chart and reach out to those providers immediately.
Let’s get our hands dirty and start sharing the details of actual events, near misses and unsafe conditions so we can quantify the volume and types of patient safety risks. The Institute of Medicine recommends:
- Reporting of health IT-related adverse events should be mandatory for vendors.
- Health IT vendors support the free exchange of information about health IT, including details relating to patient safety.
- Regular public reporting of health IT-related adverse events to encourage transparency.
And we have partnered with Quantros, a patient safety organization that publishes aggregated learnings from safety event data, to do just that. But we need other EHR vendors to come to the table with their data too.
Collectively, let’s make our systems safer and actually improve healthcare.
Join us this Friday during the #HITsm TweetChat where Stephanie Zaremba, Senior Manager of Gov. Affairs for athenahealth and Alliance for Quality Improvement and Patient Safety Board Member, will host a live discussion on health IT's role in the safety of patients. Learn more.
If you’re attending the athenahealth User Conference this April in Boston, MA, my team will be sharing our insight into this collection of analysis of patient safety incident information that comes from our first-of-its-kind partnership with Quantros. Please join me for that discussion and I hope to see you there!