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Treacherous technology

Treacherous technology

Federal oversight of health IT warranted News

Monday November 21, 2011

In a new report on protecting Americans from potential medical errors associated with the use of information technology in patient care, a committee convened by the Institute of Medicine called for greater oversight by the public and private sectors.

The report examined a broad range of health information technologies, including electronic health records, secure patient portals and health information exchanges, but not software for medical devices.

The secretary of the U.S. Department of Health and Human Services should publish a plan within 12 months to minimize patient safety risks associated with health IT and report annually on the progress being made, the report’s authors wrote. The plan should include a schedule for working with the private sector to assess the impact of health IT on patient safety.

If the secretary determines that progress toward improving safety is insufficient within a year, the U.S. Food and Drug Administration should exercise its authority to regulate these technologies. Concurrently, the FDA should begin planning the framework needed for potential regulation so that the agency is ready to act if necessary.

"Just as the potential benefits of health IT are great, so are the possible harms to patient safety if these technologies are not being properly designed and used," Gail L. Warden, president emeritus of Henry Ford Health System and chair of the report committee, said in a news release. "To protect patients, industry and government have a shared responsibility to ensure greater transparency, accountability and reporting of health IT-related medical errors."

The federal government is investing billions of dollars to encourage hospitals and healthcare providers to adopt health IT so that all Americans can benefit from the use of electronic health records by 2014, the authors wrote, but demonstrated improvements in care and safety are not yet established. Some of these technologies have significantly improved the quality of healthcare and reduced medical errors. However, concerns about potential harm are emerging as providers increasingly rely on health IT to deliver care.

Little published evidence exists that quantifies the magnitude of the risk associated with health IT problems, according to the committee, partly because many technology vendors discourage the free exchange of safety-related information in their contracts with healthcare providers.

But serious errors involving these technologies — including medication dosing errors, failure to detect fatal illnesses and treatment delays because of poor human-computer interactions or loss of data — have led to several reported patient deaths and injuries, the authors wrote.

HHS, Congressional Solutions

HHS should establish a mechanism for both technology vendors and users to report health IT-related deaths, injuries or unsafe conditions, the committee wrote. Reporting events related to patient safety should be mandatory for vendors and voluntary, confidential and nonpunitive for care providers.

In addition, the authors wrote, Congress should establish an independent federal entity to investigate patient deaths, injuries or potential unsafe conditions associated with health IT. Based on those investigations, the entity could make nonbinding recommendations, allowing flexibility for HHS, healthcare organizations, vendors and other experts to determine the best course forward.

A new health IT safety council should be funded by HHS to evaluate criteria and develop methods for assessing and monitoring safety and measuring effects of health IT on safety, the committee wrote. The agency should also ensure that health IT vendors support the free exchange of information and not discourage healthcare providers from sharing patient safety concerns, including screen shots.

Nondisclosure agreements in contracts between vendors and healthcare providers and "hold harmless" clauses that shift the liability of unsafe health IT features to care providers greatly discourage information sharing, the committee wrote.

HHS should establish quality management principles and risk management processes in designing and implementing health IT products, which can be complex and difficult for nurses and doctors to use, the committee wrote. Alerts in technology systems should be designed to have lower false-alarm rates, and computer interfaces need to be more intuitive for users.

The study was sponsored by the U.S. Department of Health and Human Services. To read an online version of the report, visit