Electronic health record safety

February 6, 2013 by MassDevice

Chief Information Officer for Beth Israel Deaconess Medical Center, records his experiences with infrastructure, applications, policies, management and governance.

By John D. Halamka, MD

On December 21, 2012, ONC issued its Health IT Patient Safety Action & Surveillance Plan for public comment

I was interviewed by the Boston Globe about the plan.

Although EHRs address a variety of safety concerns such as unreadable orders/prescriptions, drug/drug interaction checking, and fostering care coordination, they can create new problems that did not exist with paper. These problems are rare (less than 1% of quality issues reported), but they are important.

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For example, a clinician writing a paper prescription for Atenolol, a beta blocker used for cardiovascular diseases, would be unlikely to accidentally write for Ativan, a benzodiazepine used for anxiety.

However, if an EHR presents medications in a pulldown or an AJAX style lookup list, you can imagine a physician selecting the wrong medication by simple slip of a mouse.

Atelvia 
Atenolol
Ativan
Atorvastatin
Atovaquone
…

There have been several articles in the literature suggesting that badly designed software (or any software implemented poorly) can cause harm.

At BIDMC, we've used agile development techniques and rapid cycle improvement processes to enhance usability of systems, especially in response to sentinel events or clinician concerns. Our systems are developed by clinicians for clinicians.

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