HIMSS14: Sittig suggests random health IT safety surveys

ORLANDO--Health IT should be subject to randomized, unannounced, on-site inspections, said Dean Sittig, PhD, professor of biomedical informatics at the University of Texas Health Science Center, speaking during the Patient Safety Symposium at the Health Information and Management Systems Society’s annual conference.

Organizations would get six months to address any concerns discovered or they would face significant financial penalties, he said. Red flags would include poor access to computers, wireless networks having dead spots on clinical units, lack of encrypted, offsite daily backup that is periodically tested and lack of duplicated critical hardware components.

While these inspections are something Sittig says would be good for health IT, he also offered some predictions for the industry that are both good and bad. He predicts increased pressure on healthcare organizations and health IT vendors to implement changes; more health IT implementations and replacements of systems; increased government insight; and tremendous progress in health IT implementation and adoption.

Health IT also needs a method and place for practitioners to report adverse events or safety hazards due to inadequate design, development, implementation or use of health IT, he said. However, “people don’t like to report mistakes.” EHRs should facilitate automated reporting of mistakes, he said.

Vendors could do more to foster health IT safety, Sittig said. Vendors need to train users and users need to demonstrate basic competence with EHRs, he suggested. About half of people fail to perform simple tasks such as looking up the most recent test result. However, often these are the people who complain that the EHR is too hard to use. It seems they need better training.

Users also need training for managing an outage. “In our organization, we haven’t had a large downtime in the past year. That means that 25 percent of our nurses have never worked in a downtime environment,” Sittig said. Those clinicians have never ever seen paper forms let alone used them.

Health IT would benefit from enhanced certification, Sittig said, including demonstration of good software engineering practices; performance of hazard analyses of products; designing for safety and documentation of those designs; verification that systems work as designed; testing of user interfaces for usability; and vendor demonstration that they’ve addressed critical software issues identified within the past year.

Sittig also recommended more ambitious investigation of serious health IT safety concerns, akin to sentinel events investigated by The Joint Commission. Thirteen percent of healthcare organizations experienced downtime of at least 24 hours in the past three years, he said. He suggested investigation into what happened and why for downtime affecting more than 100 patients and downtime of at least 24 hours.

While health IT has come a long way, there is much room for improvement.