JAMA: EHR adoption timeline too aggressive

The push is on for healthcare providers to make the switch to EHRs but it is hard to tell how well these complex health IT systems are being implemented and used, according to a Feb. 3 commentary in the Journal of the American Medical Association.

To improve monitoring, co-author Dean Sittig, PhD, an associate professor at the University of Texas School of Health Information Sciences at Houston, and David Classen, MD, associate professor of medicine at the University of Utah School of Medicine in Salt Lake City, have called for coordinated oversight by both the healthcare providers implementing these systems and by government authorities.

Doctors and hospitals are racing to take advantage of billions of dollars in federal incentives to digitize health records, Sittig and Classen said. “However, the extremely aggressive timeline in the American Recovery and Reinvestment Act (ARRA) of 2009 stimulus package places enormous pressure on healthcare practitioners and their organizations to rapidly implement EHRs” without the time or ability to customize these systems to their local workflows, they wrote.

“Such rapid implementations could lead to significant patient safety events,” concluded Sittig and Classen.

Even under the best of circumstances, according to Sittig and Classen, implementing an EHR system is difficult, costly, time-consuming and fraught with unintended adverse consequences. Evaluation of these systems following implementation shows that some do not meet safety standards established in other industries like the airline and pharmaceutical industries, the authors wrote.

Sittig and Classen created a five-stage proposal to monitor and evaluate these systems:

• Report EHR record safety issues: It is unclear who a healthcare practitioner would contact to report a problem with an EHR system. A reporting system could be created under the new Patient Safety Organizational Statute utilizing Agency for Healthcare Research and Quality reporting formats.
• Enhance EHR certification: Vendors developing the software should be required to demonstrate that their applications have been designed for safety, developed correctly, work as designed and had all their defects fixed.
• Encourage self assessment of EHR use: Each organization should perform and document an extensive review of its clinical information systems on a yearly basis. This review should include hardware and software, clinical content, user interfaces, user training and authorization procedures, clinical workflow and communication, organizational policies and procedures, compliance with state and federal rules and regulations and periodic measurements of system activity.
• Local, state and national oversight: Random, on-site inspections by The Joint Commission or local health departments.
• Implement national EHR adverse event investigation board: The Office of the National Coordinator for Health IT could create a board to investigate EHR problems.