NEJM: National EHR-specific patient safety goals should be created

National EHR-related patient-safety goals are needed to address current problems with existing EHR implementations and failures to leverage current EHR capabilities, according to a Nov. 8 article published by the New England Journal of Medicine.

“Recent evidence has highlighted the substantial and often unexpected risks resulting from the use of EHRs and other forms of health IT,” wrote Dean F. Sittig, PhD, a professor at the University of Texas Health Science Center at Houston, and Hardeep Singh, MD, MPH, a researcher with the Department of Veterans Affairs and assistant professor at Baylor University in Houston. “These concerns are compounded by the extraordinary pace of EHR development and implementation. Thus, the unique safety risks posed by the use of EHRs should be considered alongside the potential benefits of these systems.”

“At a time when institutions are focused on achieving Meaningful Use requirements, we propose that clearer guidance be provided so that these institutions can align activities related to patient safety with the activities required to support a safe EHR-enabled healthcare system,” they continued. “A set of EHR-specific safety goals, modeled after the Joint Commission’s National Patient Safety Goals, may provide organizations with areas of focus for sustained improvements in organizational infrastructure, processes and culture as they adapt to new technology.”

Despite the need for a standardized set of electronic patient safety goals (e-PSG), staggered implementations make developing such a set difficult. A large organization with a five-year-old EHR system will have different priorities for patient safety than a small organization with a newly implemented EHR system, according to Sittig and Singh. They proposed a three-phased framework for developing standardized patient safety goals that address the needs of new EHR users, the inappropriate use of health IT and the use of health IT to identify safety issues and correct them.

The first phase of the proposed e-PSG framework would propose activities that organizations can engage in to mitigate the harmful effects of EHR downtime caused by natural or man-made disasters, and reduce the miscommunication of data transmitted between different EHR systems. The second phase would implement standards for the use of computerized provider order entry, clinical decision support and entering structured text. The third phase would impose e-PSGs to facilitate the automated identification of EHR errors.

Several federal agencies, including the Agency for Healthcare Research and Quality and the Office of the National Coordinator for Health IT, have made efforts to produce e-PSGs, but a more coordinated, consistent national strategy is required and it will depend on cooperation from all healthcare stakeholders, according to Sittig and Singh. “Creating unique EHR-related national patient safety goals will provide new momentum for patient safety initiatives in an EHR-enabled health system,” they concluded.