Joint Commission puts focus on EHR, patient safety

The healthcare industry, with the federal government at the helm, is setting sail on a voyage into the unknown: whether and to what extent patients are suffering harm from the systems that providers have spent many billions of dollars buying, and the feds many billions in incentivizing.

“That's the part we don't know,” said Dr. Ron Wyatt, medical director, division of healthcare improvement at the Joint Commission. “We know that probably less than 10% of adverse events are reported. That's how big the water is.”

The Joint Commission was called on to play a key role in the “Health Information Technology Patient Safety and Surveillance Plan” released Tuesday by the Office of the National Coordinator for Health Information Technology at HHS.

After a burst of IT adoption in recent years, the rates of hospitals and office-based physicians using “basic” electronic health-record systems now exceed 70%. “You just look at the volume and you start thinking about what are the potentials and risks of something occurring with all that data,” Wyatt said.

Under a contract with the ONC, the Joint Commission will investigate health-IT related adverse events, develop follow-up and corrective-action plans and create a database of sentinel events for further research. The work will not be part of the Joint Commission's accreditation program.

“We want to look at, where is health IT causing an unsafe condition, or a near miss or a close call, not just sentinel events,” Wyatt said. “One hospital I visited had three different, distinct systems just for medication reconciliation. You can see the risk of some type of error occurring.” A report on the first fruits of its investigations is probably a year away, he said.

HHS' Agency for Healthcare Research and Quality also will play a part in the HIT patient safety scheme envisioned by the ONC. AHRQ has developed “common formats” for the standardized reporting of patient-safety incident information by providers to federally chartered patient safety organizations. One of those formats, “Device for Health IT,” was crafted specifically for reporting by hospitals of patient-safety events involving health IT as a primary or contributing cause.

“Nobody has any good data on what the incidence of IT-related events is,” said Dr. William Munier, director of Center for Quality Improvement and Patient Safety at AHRQ.

Hospitals whose safety reporting systems use the latest AHRQ version of the standards, v 1.2, can report IT-linked cases to their patient safety organizations now, Munier said. The format is being modified—trimmed down and tweaked for relevance—for use in ambulatory care and should be ready by 2014.

The ONC plan also calls for the AHRQ to roll up the IT-linked patient safety event data from the 77 patient safety organizations to a central database for analysis via a proposed network of databases. That central database is functional and should be receiving de-identified data this year, Munier said.

Follow Joseph Conn on Twitter: @MHJConn