Advances, acceptance require new review

Beth Walsh, Editor, CMIO

Increasing use of EMRs, along with the policies relating to the associated interoperability and devices, has kept the EHR-EMR community busy. Some of our top stories this month indicate the need that hospitals and other healthcare organizations have for ongoing and more detailed guidance and instructions when implementing and using electronic record systems.

For example, the Agency for Healthcare Research and Quality (AHRQ) made available a free, online guide developed under contract by RAND, a nonprofit research organization headquartered in Santa Monica, Calif., to assist healthcare organizations with EHR implementation and use.

The guide is intended for use by healthcare organizations of all sizes to help them “anticipate, avoid and address problems that can occur when adopting and using EHRs,” according to RAND. 

The same IT systems that have the potential to enhance patient safety, improve quality of care and reduce healthcare costs, also can introduce new opportunities for error, according to John D. Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center. Health IT cannot achieve its maximum effectiveness until the potential for those errors is addressed.

In a December commentary published on the AHRQ website, Halamka considered a scenario in which a resident entering an order on her smartphone diverts her attention to a personal text message and forgets to complete the order, which results in a medication error that requires the patient to have surgery. “Such interruptions are a significant potential danger,” he wrote, citing a study that noted 4.6 average interruptions per hour for residents when considering calls, emails and face-to-face communications.

“At present, many hospitals allow clinicians to bring their own mobile devices to work, which creates a risk of mixing insecure personal applications with critical patient care applications,” he continued. Halamka suggested that hospitals develop policies, such as only allowing employer provisioned devices to be used in the workplace, to mitigate the risks associated with health IT systems. “The workflow in hospitals is changing as both systems and providers employ new technologies from a large robust full-scale EHR to a single handheld device,” he wrote.

Meanwhile, writing on the Office of the National Coordinator for Health IT's (ONC) blog, Health IT Buzz, ONC Office of Standards and Interoperability Director Doug Fridsma, MD, PhD, stated that vendors should have little choice in deciding whether their products will adhere to national standards.

“Reducing optionality improves interoperability and lowers the cost for vendors to implement, thus lowering the cost for healthcare providers as well,” Fridsma wrote. “ONC is identifying the vocabularies, the message and the transport of ‘building blocks’ that will enable interoperability,” he continued. “While vendors should be able to flexibly combine them to support interoperable health information exchange, these ‘building blocks’ need to be unambiguous and have very limited (or no) optionality.”

There’s little doubt that we’ll see more of these types of policies and commentaries as the health IT community continues to work toward maximizing all of the potential benefits IT systems and products can provide.

Beth Walsh
CMIO Editor
bwalsh@trimedmedia.com