Memorandum for Board of Directors
It is common knowledge that most organizations are adopting technological advancements to better their service delivery techniques. Healthcare is no better. Healthcare professionals and personnel are increasingly incorporating and employing technology-based alternatives to support and improve healthcare delivery. Electronic Health Records are rapidly gaining traction all over the world. Information systems technologies are utilized to store retrieve and exchange medical data and information thus allowing seamless provision of healthcare across social, cultural, geographical and temporal barriers.
As mandated by my job description as the CIO I would like to comment on the safety of Electronic Health Records in response to the impending adoption and implementation process in the institution. As outlined by some directors, there has been recent news and publications citing usability dissatisfaction on the part of clinicians and safety on the side of the patient. I would, therefore, like to elaborate more on this and give my point of view.
Various news agencies have reported special reports examining the shift of many US healthcare facilities to electronic health records. The report ponders questions that physicians and patients are asking concerning the usability of EHR and associated errors. The most important issue highlighted in the report is the fact that the most dangerous time for patients and physicians appears to be immediately after implementation of the system. It is important to note that the introduction of a new system comes with usability challenges because of staff learning curve. Likewise, a myriad of operational issues may occur that need fixes to get the EHR system working properly and reliably. In that respect, the institution needs to implement EHR system in a coordinated and organized manner that factors in all this factors. In my view, a fall back strategy should be adopted. A prototype should be implemented while the recent systems are used to ascertain total usability and operational fixes. The users of the system should be adequately trained through nicely crafted programs that suite each scenario. This may require additional resources but the results are favorable. Likewise, to reduce usability concerns with the physicians and the doctors, a trusted vendor/efficient design team conversant with the healthcare should be appointed. This ensures that the implemented software does not raise usability/user interface problems. As Jodi Daniel, director of policy and planning for the ONCHIT, available evidence does not link health information technology to safety issues in healthcare. The organization should continue with its implementation plan considering the aforesaid issues.
The American College of Emergency Physicians has also found disturbing revelation that poorly designed EHR systems might be resulting in communication failure, wrong patient order and errors, alert fatigue and poor data display.
Another vexing concern is the assertion that there is insufficient evidence to indicate whether health IT improves or importantly, cause more harm in terms of patient safety. This is apparently attributed to the fact, unlike medical devices, reporting of EHR problems to the US Federal Drug Administration is not a requirement by law. The situation is exacerbated by the difficulty in evaluating whether an EHR problem is a design flaw such as a poor interface that encourages and hides errors or a software-related problem. Further EHR vendors instill bottle necks in form of hold harmless clauses and nondisclosure clauses that prevent the reporting of errors associated with certain software. Patient identification is another hurdle that has popped up more commonly among services providers, insurers and governments. Patient identification is a fundamental pillar to research studies that promotes the provision of healthcare and its improvement to suit the needs of the population. The United States government under the Department of Health and Human Services prohibits the establishment of national patient identifiers to sufficiently link providers’ patient database and transaction systems for increased transparency in care management.
The patient identification policy is a positive step towards protection of patient’s medical data and information. The information system can harm patients if unethical practices such as unauthorized access to patient data are reported. The federal government prosecutes personnel suspected of orchestrating and aiding such malpractices. Providers are coping with this federal provision by utilizing technology to flag suspected duplicate identities with varying degree of certainty. Some are utilizing their EHR vendor’s technologies to identify patients positively while others are using old technology used by payers such as smart cards, biometric features.
A major call for EHR vendors to eliminate hold harmless and gag clauses is ongoing. The exercise is expected to alter the contractual responsibility that deters collection of data pertaining problems in EHR’s. A similar campaign has been initiated by the Institute of Medicine to petition the US Department of Health and Human Services to fund Health IT Safety Council in developing an assessment and monitoring criteria for safe health IT in their use to promote safety. Further, a consensus is being sought by various medical professional entities and bodies such as IoM, ACEP and ONCHIT to give a comprehensive meaning of evidence as used in the medical context.
Noting the above, I wish to give a go ahead pending your decision for the implementation of the Electronic Health Records. The system will accord the medical facility and the patient a host of upsides such as efficiency, cost and better service delivery. The challenges outlined can be managed from an institutional, industry and government level.
Thank in advance
Chief Information Officer
Charette, R. N. (2013, June 27). How Often are EHRs Placing Patients at Risk? IEEE Spectrum .
IT., O. o. (2007, June 19). The Benefits & Risks ofElectronic Health Records. North Carolina Healthcare Information and Communication Alliance .
Mace, S. (2013, July 31). Despite EHR, Patient ID Problems Persist. HealthLeaders Media .