Electronic Health Records

Adoption & Implementation News

ONC Offers Recommendations for Safe, Effective Health IT Use

Recommendations focus on EHR implementation and health IT use to promote patient safety among providers.

By Kyle Murphy, PhD

The Office of the National Coordinator Health Information Technology (ONC) has ramped up its efforts to promote proper health IT implementation and use and ensure patient safety.

On Monday, the federal agency announced the availability of two new reports on health IT safety, one providing recent evidence of the benefits of health IT to patient safety and the other recommendations and solutions for addressing potential patient safety issues with health IT systems and services.

As ONC CMIO Andrew Gettinger, MD, who directs the Office of Clinical Quality and Safety, stated on the federal agency's official blog, the reports highlight key elements of health IT safety which serve as focal points at ONC.

"Evidence continues to indicate that health IT safety is dependent not just on EHR systems themselves, but on a complex interplay of factors, including an institution’s leadership, culture, readiness, installation practices, training, and handling of upgrades.  Improving safety requires attention to all of these areas," he noted.

"Efforts to enhance usability and interoperability across the health IT landscape also provide important opportunities to improve the safe use and safety of health IT," Gettinger added.

Of more immediacy is the second of two reports which contains recommends from ONC and others on the safe implementation and use of health IT.

So what does it contain?

"Health care organizations and practices interested in addressing these challenges need to know where to focus their efforts and which problems to prioritize," the authors of the revised report wrote. "To facilitate that process, we surveyed relevant literature and Web sites of widely respected organizations working in health care quality and safety."

The recommendations span two categories — specific recommendations for adoption and implementation and specific recommendations for use in practice.

Of the former, there are six separate areas of focus:

  • Leadership
  • Culture and engagement
  • Planning and readiness
  • Installation
  • Training and proficiency support
  • Upgrades and conversions

The first two are non-technical in nature, emphasizing the importance of buy-in from different departments and levels of leadership to ensure that health IT safety remains paramount throughout the EHR implementation an adoption processes. The remaining recommendations each requires an assessment and action plan for reaching EHR implementation and adoption goals.

As for health IT use, the recommendations are five-fold and straightforward:

1. Clinical Documentation: In the context of health IT, we use clinical documentation to mean patient identification, prepopulated fields, and practice-specific metrics and reporting. Goals, priorities, and recommendations address policies, procedures, and practices that ensure the accuracy of practice-level data and reduce the risk of error.

2. Data: Goals, priorities and recommendations address methods to ensure the accuracy, availability, and timeliness of patient-level data, and to identify errors and missing data.

3. Workflow: Integrating health IT into clinical workflows properly helps ensure the timely and effective use of health IT. Goals, priorities, and recommendations included here address issues such as ease of system use as well as overriding alerts and similar system workarounds.

4. Communication: We use this term to mean communication between clinicians. Goals, priorities, and recommendations included here address methods to ensure effective communication about critical information. With the large body of data available for viewing in an EHR, the most critical information in system displays should be made prominent; distractions in the display should be minimized and in-person communication should not be replaced or reduced by existence of the system.

5. Medication Management: We use this term to mean system-based functionalities such as decision support to prevent adverse medication interactions and improve medication safety, manage order fulfillment, and reduce medication problems.

A report in The Washington Post has highlighted the challenges to patient safety caused by EHR use and specifically alerts. That follows the publishing of top health IT hazards by the ECRI Institute late last year.

"With all of the issues that hospital leaders are dealing with, technology safety can often be overlooked," CEO Anthony Montagnolo said at the time. "Based on our experience with independent medical device testing in our laboratory, accident investigations, and reported events, we're very aware of serious safety problems that occur."

Given the high levels of EHR adoption among US providers, the need for identifying and addressing health IT-related patient safety risks is only growing in importance.

Dig Deeper:

Hospitals Lag in CPOE Implementation, Errors Persist
Study Supports Alarm Fatigue Concern with Physician EHR Use




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