“Many care decisions today are based on data in an EHR or other information system,” according to an ECRI Institute report on patient safety risks, “and incorrect data can result in incorrect treatment, potentially resulting in patient harm.”
“In addition, as EHR data ﬂows through health information exchanges [HIEs] to other health systems, the inappropriate data can affect multiple areas and systems. Even once a problem has been discovered, the task of examining records and distinguishing which data belongs to which patient can be monumental.”
That’s a pretty good way of distilling a complex chain of custody for a patient’s data through what will eventually be a national network of HIEs. As such, it ranks #4 on the health care technology think tank’s top 10 health technology hazards list for 2013.
Maine HealthInfoNet CEO Devore Culver expressed a different facet of the same issue, telling SearchHealthIT, “meaningful use has done us no favors” in standardizing health data inside the continuity of care documents (CCDs) that fire across HIEs from one health care provider to another.
To mitigate the issue, ECRI recommends:
- Check your workflows. Are they patient-centric or location-centric? Tuning them to make them follow the patient around instead of reconciling data from a bunch of different locations is preferred.
- With devices that feed data into the EHR system, make sure workflows take into account those that move from patient to patient such as spot-check monitors and ventilators, so that they are connected to the right record at all times.
- Check your test procedures. Create pre-implementation workflow testing processes where test data can’t possibly be intermingled with live patient data, a source of some of these errors.
We have a couple more ideas:
- It’s time for a national patient identifier. Let’s stop pussyfooting around and making this very obvious data fix a political football. At least your data will remain associated with you through the HIE, from pathology to primary care to e-prescribing to radiology to emergency room to whatever care provider tomorrow brings to your doorstep.
- Standardize data inside the CCD to help HIE leaders “paint a pretty picture” of you in every physician’s EHR where your data may flow. Some thought leaders we interview say the Office of the National Coordinator for Health IT should just declare by fiat how this will work, and others favor a stakeholder-negotiated plan. Who cares, as long as it’s not a free-for-all.
There are probably a hundred more things that could be done to make data less prone to getting mixed up between patients or corrupted in other ways (ECRI’s last tip? “After implementation, verify that the system is working as planned”). The main thing for provider CIOs to remember is: Right now, this is a top safety hazard, no matter who’s ranking it or where it falls in the top 20. Addressing these issues sooner than later is essential to the future of our burgeoning health IT network launched with HITECH in 2009.