EHRs: now safety, info exchange concerns (US, AU, CA)

What’s this? EHRs reducing, not increasing, safety? Reports from both the US and Australia seem to indicate another spanner (US: wrench) in the EHR works, aside from the laggardness in achieving the HITECH Act’s goals [TTA 27 Mar].

  • The Joint Commission, which is the chief US accreditation and certification body for healthcare organizations and programs, and thus to be taken very VERY seriously, released a Sentinel Event (Patient Safety Event) Alert yesterday. It warned of EHR-related adverse events affecting patient health, resulting from incorrect or miscommunicated information entered into EHRs. Interfaces built into the technology can contribute and studies have documented mixed results in the systems’ ability to detect and prevent errors. It identifies eight key factors,led by human-computer interface, workflow and communication and clinical content, that can lead to a sentinel event and three major remedy actions. While the JC does take pains to confirm the positive effects of well-designed and appropriately used EHRs, with strong clinical processes in place, it is the first ‘red flag’ this Editor can recall waving at the EHR bandwagon. (Correct me if I am wrong)  PDF (link) Hat tip to Arthur Allen and Ashley Gold at POLITICO’s Morning eHealth today.
  • In Australia, 30 doctors under contract with their Department of Defence resigned rather than work with the CSC-designed EHR, based on concerns that the patient record and that patient’s details, entered by a doctor, could be altered by another party, such as a nurse and a similar situation with pharmacy records (modeled after NHS and not the Australian system). The counter-argument is safety-related and the existence of an audit trail. In a situation oddly reminiscent of the troubles plaguing the US DOD’s EHR system AHLTA, the development of the Joint eHealth Data and Information, or JeHDI, project starting in 2011 was budgeted at AU$23.3 million and ballooned to $133.3 million, a mere bag of shells compared to AHLTA’s (US) billions in fixes, upgrades and failed interoperability with VistA [TTA 31 Mar]. The Australian

The Canadians are also experiencing problems relating to their EHR implementation, especially in data exchange. The CD Howe Institute is stating that “only 12 percent of physicians are notified electronically of patients’ interactions with hospitals or send and receive electronic referrals for specialist appointments, and fewer than three in 10 primary care physicians have electronic access to clinical data about a patient who has been seen by a different health organization.” And this is with a single-payer system. Hmmm. More in HealthDataManagement  CD Howe study

Finally, for those of us who hoped that HIEs, or health information exchanges, could function on at least a state or local basis as a workaround for interoperability, it might be not worth the bother. A meta-study of 27 research studies found that while directionally positive (57 percent), studies with ‘strong internal validity’ were less likely to associate HIE with benefit. Their headline says it all for the writers’ conclusion: “There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care.” Published in this month’s Health Affairs (abstract; full text requires payment) HealthDataManagement

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