The growing adoption of complex health technology in hospitals is expected to reduce errors and improve the quality of care, but increased utilization of health IT-based technologies comes with its own set of risks for healthcare providers.
Three of the health technology hazards cited on the ECRI Institute's annual list of the top 10 health technology hazards are associated with the maturing health IT market. The ECRI Institute is a not-for-profit organization that researches patient safety, quality and cost-effectiveness of care.
The IT hazards on the annual list are patient-data mismatches in electronic health records and other health IT systems; interoperability failures with medical devices and health IT systems; and caregiver distractions from smartphones and other mobile devices.
The inclusion of the health IT-based technologies on the list reflects “a growing use of health IT-based technologies,” said James Keller, vice president of health technology evaluation and safety for the ECRI Institute. “It's important to adopt interoperable technology but be more mindful of the risks,” Keller said.
Only one of the items on last year's list—failure to manage changes in device connectivity with health IT—addressed health IT-related technologies.
The ECRI Institute recommends that healthcare facilities pay attention to health IT when prioritizing safety initiatives for next year, noting the complexity, potential to introduce new sources of failure, and the possibility that such failures would impact many patients before they're recognized.
Keller noted that while paper charting can also lead to errors, the ability of health IT systems to transit data to a range of technologies can multiply the effects of a clinician's or system's error. Such errors can decrease the buy-in from clinicians and create a lack of confidence in the technology itself, he added.
Other organizations have also expressed concern about the risks of health technology. Late last year, the Institute of Medicine released a report titled Health IT and Patient Safety that called for better oversight of health information technologies, such as EHRs, secure patient portals and health information exchanges.
“Designed and applied inappropriately, health IT can add an additional layer of complexity to the already complex delivery of healthcare, which can lead to unintended adverse consequences, for example dosing errors, failure to detect fatal illnesses and delayed treatment due to poor human–computer interactions or loss of data,” according to the IOM.
Healthcare providers, particularly academic medical centers, have been looking at the interoperability issues between devices and health IT systems for several years.
However, many devices have historically been designed for use in isolation, and there is currently a need for manufacturers to better align their products with the vision of health IT, said Dr. Julian Goldman, director of the medical device interoperability program at Massachusetts General Hospital in Boston and the Center for Integration of Medicine and Innovative Technology.
Goldman is also the founder of a federally funded program that aims to encourage adoption of fully interoperable devices and health IT systems. The Medical Device Plug-and-Play Interoperability Program, or MDPnP, works with participating health systems to set requirements, such as sample contracting language, about how they procure and use medical devices.
The document outlining purchasing requirements was re-released in August when the Veterans Affairs Department joined as a signatory. Other participating health systems include Partners HealthCare, Kaiser Permanente and Johns Hopkins Medicine.
“We haven't, as a healthcare community, been crystal clear about what we want to achieve with interoperability of devices,” Goldman said. He added that providers have to deal with basic inoperability challenges, such as ensuring that a device's clock is set to the right time, which must be set manually on most medical devices.
Researchers gathered data from two Partners HealthCare hospitals in Boston—Massachusetts General Hospital and Brigham and Women's Hospital—as well as the Hospital of the University of Pennsylvania in Philadelphia and Johns Hopkins Hospital in Baltimore. They looked at 1,324 devices ranging from infusion pumps and ventilators to anesthesia machines and found that the average offset was about 33 minutes and the maximum offset was nearly 17 hours.
The lack of time synchronization can lead to “inaccurate time stamps of clinical data recorded in the electronic medical record” and can “complicate the synchronization of data from multiple devices when analyzing adverse events,” according to the MDPnP website. “How can we improve the quality of healthcare if we can't get the data?” Goldman said.
Other top hazards cited on this year's ECRI Institute list include alarm hazards, medication administration errors using infusion pumps, and unnecessary radiation exposures and radiation burns during diagnostic radiology procedures.