Is it time for your summer vacation? Will you pull out your map and plot a course or is that too old fashioned? Maybe your road trips are as high tech as the rest of your life and you’ll navigate with Google Maps on your iPhone. The only low tech part of your trip may be cranking down the windows while listening to Willie Nelson sing, “On the road again, just can’t wait to get on the road again…”
On July 17 the Office of the National Coordinator for Health IT (ONCHIT) released travel plans in the form of the Health IT Safety Center Roadmap. In the announcement about the Roadmap release, ONC notes that the goal of health IT is to enable safe, high-quality care. Despite great improvements in health IT there are still some inherent issues that do not foster patient safety, such as limited interoperability and lack of integration into clinical workflow. The Health IT Safety Center Roadmap outlines activities to promote health IT safety by bringing together health IT stakeholders, disseminating best practices, and creating a voice for the role of IT in patient safety.
Impact on EHR developers
ONC currently has EHR certification requirements for Electronic Health Record (EHR) safety-enhanced design. As part of certification requirements EHR developers must demonstrate a User-Centered Design development process and must complete usability testing that shows good performance in IT safety areas including:
- Computerized Provider Order Entry (CPOE)
- Drug-drug, drug-allergy interaction
- Medication list
- Medication allergy list
- Clinical Decision Support (CDS)
- Electronic medication administration record
- e-Prescribing
- Clinical information reconciliation
A Culture of Safety
Dialysis facility patient care has been focused on patient safety for years, most recently with formal efforts to move beyond just recognizing safety issues to creating a facility “Culture of Safety.” In 2012 Drs. Garrick, Kliger, and Stefanchik published a CJASN article, which provides an overview of the ESRD-focused Culture of Safety.1 Based on CMS regulations, the dialysis facility Medical Director is responsible for the Culture of Safety in the facility. Previous research has identified common facility safety-risk areas including:
- Communication/miscommunication
- Medication errors
- Patient falls
- Errors in machine/membrane preparation
- Failure to follow established policies
- Lapses in infection control practices
Part of improving safety is identifying common risks, establishing performance improvements goals, and incorporating best practices, but the Culture of Safety involves openly sharing safety-risk findings in a “blame-free” environment, with open communication about concerns and errors. This safety culture focuses on examining policies, processes, and human factors to see “what happened, why it happened, and what to do to prevent it from happening again” without blaming individual(s).
A trusted space
Much like the Culture of Safety in the dialysis facility, the Health IT Safety Center Roadmap recommends establishing a national Health IT Safety Center. The Center will be a “trusted space” to collect and review health IT safety concerns and develop solutions. It will foster health IT stakeholder collaboration to focus on these key areas:
- Solutions to address health IT-related safety events and hazards
- Improving identification and sharing of information on health IT-related safety events and hazards
- Reporting on health IT safety and solution evidence
- Promoting health IT safety education and competency of clinicians in the appropriate and safe use of health IT
The Center will be a physical office space with an Executive Director and staff, supported initially with Federal seed money. ONC is seeking a partner to donate office space and overhead support. The Roadmap includes a 5-year projected budget noting that the Center will require future private and public funding.
A focus on solutions
Specific health IT safety risks have been identified from various sources including Patient Safety Organizations (PSOs) and medical malpractice databases. Data from The Joint Commission revealed high-priority EHR safety issues including:
- Problems with user interfaces
- Poor support for workflows and communication
- Inadequate clinical content
As the Health IT Safety Center drives to impact patient safety, it is designed to function with the following values and attributes:
- Dedication to shared learning and shared responsibility
- A solutions focus
- A foundation of private sector initiatives, not a government regulatory body
- Commitment to clinical users of health IT and their patients
- Public-private partnership
- A trusted, learning, non-punitive environment
- Transparency
Those of us who develop and use health IT are stakeholders in the culture of health IT safety. We have a responsibility for local safety team participation in the dialysis facility or hospital as well as support of national health IT safety initiatives. Look for news from the national Health IT Safety Center and improvements in healthcare informatics safety features in the future. With the Health IT Safety Roadmap we may find ourselves like Willie Nelson in Honeysuckle Rose, “Goin’ places that we’ve never been.”
1. Clin J Am Soc Nephrol. 2012 Apr; 7(4): 680–688. doi: 10.2215/CJN.06530711
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
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