HIT leads list of top 10 safety concerns

By Erin McCann
10:54 AM

Health information technology systems have made their way to the No. 1 patient safety concern for healthcare organizations, according to the findings of a new ECRI industry report.

The report, which includes data on more than 300,000 safety event reports, underscores healthcare's top 10 patient safety concerns for 2014 and puts data integrity failures with HIT systems at the very top.

"Health IT systems are very complex," said James P. Keller, vice president of technology evaluation and safety at the ECRI Institute, in the report. "They are managing a lot of information, and it's easy to get something wrong."

Keller cited data entry errors, missing data, improper copy-and-paste behavior and inappropriate use of default values as some of the ways data can be seriously compromised -- compromised to the point where health IT systems' data integrity failures were also included in ECRI's top 10 health hazards.

[See also: ECRI: 10 top health tech dangers and EHR copy and paste? Better think twice.]

Using default values, in particular, can significantly harm the patient, according to a fall 2013 report by the Pennsylvania Patient Safety Authority. The report found that out of 324 verified default events, six resulted in "unsafe conditions," and two more resulted in temporary harm to the patient that eventually required intervention. One of these events was due to a default dose of morphine, and the second was due to a default administration time which proved ultimately too close to the patient's last medication dose.

To prevent compromised integrity of these systems such as inappropriate default value use, ECRI officials put forth several recommendations for healthcare organizations.

The first being testing the systems and interfaces themselves, ideally in a simulated setting to ensure the system functions as intended.

Next, system users have to be properly trained and supported. There needs to be a mechanism for employees to report issues when they are discovered, so the problem can be fixed in a timely manner.

Lastly, it's all about clinical workflow. You need to know how the systems are used by employees in practice, not just how theoretically they're supposed to work.

Indeed, data integrity problems are not just cited by ECRI officials. They're on the radar screen of virtually the entire industry. AHIMA, for instance, in a 2013 report also outlined several health information exchange risk factors that threatened data integrity.

AHIMA members Grant Landsbach, data integrity manager of Sisters of Charity of Leavenworth and Exempla Health System, and data integration consultant Beth Havenke Just pointed to relying on weak algorithms as the No. 1 risk factor to compromising data integrity.

"There is a prevailing belief that the record matching algorithms standard within a number of health information systems will adequately identify and manage duplicate records," they wrote. Resultantly, many HIM officials may resort to a "hands-off approach," regarding duplicate records. Therein lies the risk. "When HIO and EHR administrators rely too heavily on these algorithms and auto-merging to manage duplicates, the end result is often overlaid records -- which can ultimately be more dangerous than duplicates since information can be merged into the wrong record," they wrote.

Landsbach and Havenke Just also cited failure to incorporate health information management staff into the the algorithm process, lack of standard interfaces and establishment of weak governance processes.

ECRI's 2014 top 10 patient safety concerns:

1. Data integrity failures with
health information technology systems*
2. Poor care coordination with patient’s
next level of care
3. Test results reporting errors
4. Drug shortages
5. Failure to adequately manage behavioral
health patients in acute care settings
6. Mislabeled specimens
7. Retained devices and unretrieved fragments*
8. Patient falls while toileting
9. Inadequate monitoring for respiratory
depression in patients taking opioids
10. Inadequate reprocessing of endoscopes
and surgical instruments*

*These items were also included in ECRI's top 10 health hazards list.

"In a time of competing priorities and limited resources in healthcare, we encourage facilities to use the list as a starting point for patient safety discussions and for setting their patient safety priorities,” says Karen P. Zimmer, MD, medical director of ECRI Institute’s patient safety, risk, and quality group and of ECRI Institute Patient Safety Organization, in an April 22 press statement.

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