HITPC: Recommendations for HIT safety center debated, approved

A new Health IT Safety Center should serve as a central point for a learning environment, complement existing systems, facilitate reporting and promote transparent sharing of information regarding patient safety, according to the findings of the HIT Safety Task Force presented at the July 8 Health IT Policy Committee meeting.

A safety center could adapt the governance structure of the National Transportation Safety Board, which investigates airline incidents, said David Bates, chair of the task force. The model of the lesser known ASIAS (the FAA's Aviation Safety Information Analysis and Sharing) also was found to be relevant to a health IT safety center. ASIAS conducts national aggregation of individual airline safety data, is data driven, includes multiple institutions voluntarily sharing data, is non-punitive and serves as a trusted third party with deep technical expertise. ASIAS also started small but now includes 98 percent of the industry, selected manageable problems and has a large and broad board as well as a smaller executive board.

Bates recommended a public-private governance structure for the center, which should sit outside of government but be resourced at least in part by the Office of the National Coordinator for Health IT (ONC). The center also needs to avoid duplication of existing activities. The center needs clearly defined missions with related priorities and should include both institutional and individual members. Its agenda should be driven by frontline provider concerns, he said.

The center also should address all types of health IT, not just EHRs. It should serve as a learning forum, but not an enforcement entity. It must consider sociotechnical issues as well as technical issues. It should incorporate a variety of data streams, not just adverse event reports, as well as near misses and hazard reports. The center should primarily focus on broad trends and sometimes on serious individual events.

Bates said the task force saw the center as serving the following key functions:

• Engagement of key stakeholders
• Analysis
• Convening
• Education and dissemination

He also highlighted the need for full transparency. Although it might not have the legal protection of patient safety organizations, the center would have to maintain transparency. The center should not be regulatory, but make policy and develop standards itself.

The center should avoid interrupting relationships between clients and vendors in which they already exchange safety information; duplicating existing efforts; and assuming that reporters can identify whether an incident is health IT-related. “Often, it’s very hard to tell,” Bates said.

The Health IT Safety Center has “the potential to deliver substantial value,” Bates said, although it would need adequate resources and longitudinal support.

Several members of the Health IT Policy Committee questioned whether the center is really necessary, asking if it is just recreating the wheel or establishing another bureaucracy. When asked why the process could not be more similar to the Joint Commission sentinel event reporting process, Bates said the events that organization investigates represent “a very, very tiny fraction of all the harm that occurs in this country. They do not get to the vast majority of the issues that this center would be interested in.”

After much debate, the committee voted to approve the recommendations made by the Safety Task Force.