The Texas Medical Association is calling for appointment of a federal health information technology safety czar, while the American Medical Association wants to see more health IT safety research focused on systems in ambulatory care.
The requests from the largest state and the largest national medical societies came in response to formal requests for comments on HHS' 39-page HIT Patient Safety Action and Surveillance Plan (PDF)
released last December.
The 47,000-member Texas organization, in a four-page letter to Dr. Farzad Mostashari (PDF)
, head of the Office of the National Coordinator for Health Information Technology at HHS, said: “TMA believes that significant patient safety risks exist now and new ones will emerge in the next one to two years as many EHR and other HIT vendors merge or go out of business. Therefore, it is imperative to set mandatory deadlines and have a robust reporting and learning system in place now, not later. We are extremely concerned that the proposed plan lacks the specificity necessary for success.”
The Texans also recommended the appointment of a “highly visible HIT Safety Czar” to promote health IT patient safety “across the multiple programs, developers and end users.”
“The important thing about the Czar, he could champion and market, the same thing Farzad is doing for EHRs, he'd be doing for safety,” said the author of the letter, Dr. Joseph Schneider, chairman of its committee on health information technology, on behalf of the Texas Medical Association. Schneider is chief medical information officer and medical director of clinical information at Baylor Health Care System.
The 217,500-member AMA, in a three-page response
by its Executive Vice President and CEO Dr. James Madara, said the ONC's commitment to issue guidance on implementing technology “will be very helpful.”
“While research has been done on health IT systems and patient safety in the hospital setting, there has been limited research on the impact of EHR use on patient safety in the ambulatory setting,” Madara wrote. “Physicians are concerned about potential liabilities from EHR system design and software flaws as well as lack of interoperability among EHR systems that could result in incomplete or missing information, which may lead to errors in patient diagnosis and treatment. The AMA believes more research is needed in the ambulatory setting to determine and monitor the effects of EHR use on patient safety.”
In 2010, Sen. Chuck Grassley (R-Iowa)
very publicly began a probe into allegations that EHR vendor contracts contained gag clauses that prohibited users from sharing information about glitches in their systems. Not much came of the inquiry, but that didn't mean the overarching problem, a lack of transparency on IT safety issues, was resolved..
“It may not be in the contract, but from a practical matter, if you're a hospital and have a problem with your EHR, it's extremely difficult to convince the vendor that they have a problem,” Schneider said. “If you publicly air those concerns, he said, “you're spreading you have a system that doesn't take care of problems well. There is sort of a virtual gag; if you say something and it gets out, it has negative consequences. "
The federal plan calls for reporting of software problems to regional patient safety organizations. Texas wants to do one better. “We're advocating for having a single PSO to do this and do it well. You need one place where this is all brought together.”
Consider a computer program that has an icon to denote a medication, such as a heparin drip, has been discontinued, Schneider said. But for a new nurse coming on shift “this tiny icon that's supposed to look like a hand, doesn't, and couldn't for anyone over 55 years old.”
“Until you get a bunch of similar circumstances, if you don't get enough in a single PSO, you can't see the patterns,” Schneider said. "The government should provide seed money and have discussions (about) how do we get the money from healthcare organizations to fund it long term,” Schneider said.
“I'm a technology advocate from way back, but we've got to come at this with patient safety first and foremost,” Schneider said. “Technology can improve patient safety, but there are many, many studies now that say it can harm it. We're rushing pell mell into introducing new things that are, in some cases, inadequately tested. And that can lead to errors. We have to have a balanced approach that says, let's get the new stuff in, but let's not create problems getting it in.”