Can the Health IT Safety Center succeed?
Writing in Health Affairs, two experts offer some tips to help it meet that "monumental, sociotechnical challenge."
ONC wants to use the safety center as a convener for stakeholders from across healthcare to accomplish two interrelated goals: "using health IT to make care safer, and continuously improving the safety of health IT."
[See also: ONC unveils patient safety roadmap]
That will take work, and lasting commitment from a broad array of different players, according to Dean Sittig, professor of biomedical informatics at The University of Texas Health Science Center at Houston, and Hardeep Singh, research scientist at Baylor College of Medicine.
On the Health Affairs blog, Sittig and Singh call the roadmap "an important step for both policy and practice in an area where researchers like us are just beginning to understand the boundaries and definition of health IT-related patient safety."
They also offer their thoughts on the challenges that must be addressed if the Health IT Safety Center is to be brought to fruition – and truly brought to bear on technology-enabled quality improvement.
As the public-private organization gathers folks from the different facets of health IT to help develop a "learning health system" (in one of ONC's favorite turns of phrases) where continuous improvement of patient safety is the goal, the diverse participants would work to spotlight ways to address IT-related adverse events, aim toward better evidence-based practices and information sharing and promote education for clinicians' safe use of healthcare technology.
But as Sittig and Singh point out, that's easier said than done.
"Why hasn’t all of this been done by now? The answer lies in the complexity of health IT use," they write. "In addition, research to understand unintended consequences of health IT has emerged mostly in the last decade. As recognized in the roadmap, a comprehensive, sociotechnical approach is essential; this must include technical factors, as well as nontechnical factors such as people, workflow and organizational issues."
[See also: EXTREME essentials for interoperability]
Several years ago, the two researchers published a study titled "A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems." They've also done extensive research on how electronic health records can help deliver on patient safety. Through that research, they offer a three-part framework for defining safety as it relates to technology. It involves:
- Activities to mitigate risks that are unique and specific to technology (e.g., safety issues related to unavailable or malfunctioning hardware or software);
- Issues created by the failure to use technology appropriately or by misuse of technology (e.g., hazards created by nuisance alerts in the EHR), and
- Use of technology to monitor health care processes and outcomes and identify potential safety issues before they can harm patients (e.g., the use of EHR-based algorithms to identify patients at risk for medication errors or care delays).
Addressing all three of those is a tall order, they write; the safety center, even as a "trusted space where stakeholders [can] convene to review evidence and jointly develop solutions" (in ONC's words), will face challenges – especially when it comes to improving identification and sharing of health IT-related safety events.
"Our research shows that identifying EHR-related patient safety issues or delineating the role technology plays in a safety event is difficult," write Sittig and Singh. "For example, when clinicians overlook abnormal test results in EHRs, nearly all eight sociotechnical dimensions" – as defined in their earlier report – "can be involved."
So, while the proposed center wouldn't conduct investigations into adverse events, they write, "we believe EHR-enabled healthcare organizations should themselves create multi-disciplinary EHR safety teams to investigate safety events with potential 'health IT involvement.'" Such teams could work with patient safety organizations during investigations "and be integrated with an organization’s risk management infrastructure" they suggest.
That proposal is just one of many Sittig and Singh have to offer. Read their full post here.
In the meantime, they write, "safe and effective implementation and use of health IT within a complex adaptive health care system is a monumental, sociotechnical challenge. The proposed Safety Center is a step forward, but it will require strong and sustained support from a multitude of stakeholders, including vendors, researchers, and policymakers. A great deal is at stake here. In the absence of any other central oversight, the Safety Center will need to lead the way in making health IT safer and better, so we can improve the health and health care of our patients."