WASHINGTON – There's little question that electronic health records reduce adverse drug events and improve quality of care. But that doesn't mean healthcare providers shouldn't be doing all they can to make sure they're as safe and as easy to use as possible, said National Coordinator for Health Information Technology David Blumenthal, MD.
Blumenthal made those comments at the launch of EHRevent.org, a new safety reporting system that will allow healthcare providers to report adverse issues related to the implementation and use of EHRs. EHRevent.org "is an important piece of the puzzle to make sure that happens," he said.
The system was launched by not-for-profit iHealth Alliance, which is composed of medical society and professional liability carrier executives in collaboration with federal agencies (such as the U.S. Food and Drug Administration), and the PDR Network, which is hosting EHRevent.org under the guidance of the alliance.
EHRevent.org uses a standardized online format that will collect reports from physicians and other healthcare providers who use EHRs and create reports to help educate providers on the potential challenges that EHR systems may bring.
The purpose of the network is to put event reporting at the fingertips of physicians, said Edward Fotsch, MD, CEO of the PDR Network.
The network will integrate the system into participants' websites, including those of EHR system vendors. For example, a participating EHR vendor would have the link to EHRevent.org embedded into its solution so that doctors could click on it to fill out a report form.
The form requires answering nine fields, but allows providers to add more detailed information about the event. This information would then be de-identified and stored in a patient safety organization (PSO), a federally designated entity designed to keep the information safe and secure.
By collecting this information, providers will be able to show trends related to EMR problems rather than just anecdotes, said Nancy Dickey, MD, chairman of the iHealth Alliance, president of the Texas A&M Health Science Center and vice chancellor for health affairs in the Texas A&M University System.
"This is an opportunity to discern patterns and learn lessons," said Blumenthal, who noted that assuming that it's just the technology's fault is premature.
Fotsch said the majority of EHR problems occur during education and training. He said this would be reported under "pilot error."
David Troxel, MD, medical director of The Doctors Company, a physician-owned professional liability insurer, said he is aware of three recent EHR-related medical malpractice claims. Two of the cases suggest problems that occurred during the transition from paper to electronic records.
Troxel called this a "perilous period."
"We participated in this system (EHRevent.org) because we all know that any time new technology is adopted there are unintended or unanticipated events that occur," he said.
In both cases physicians weren't alerted to the fact that patients had abnormal test results. Troxel said there is always the possibility that key information, when scanned into a patient's record, can get lost. He suspects that the tests were perhaps filed in a folder somewhere else, and the physicians didn't know where to look for them or they weren't scanned into the latest test portion of their records. Both patients were eventually diagnosed with advanced cancer.
The third case deals with an independent practice association that negotiated a single EHR contract user agreement for its practices. The unintended consequence was that every doctor in the association had access to each other's patient records – including patients they'd never seen or never would see.
This violates the privacy rules under HIPAA, said Troxel, noting that there's still uncertainty about how to deal with an issue like this.
EHRevent.org "can create a mechanism where (physicians) can share problems like this and nip them in the bud early," he said.
"The time is now to collect data," said Lawrence Smarr, president and CEO of the Physician Insurers Association of America.