Posted by: Jenny Laurello
EHR, electronic health records, Institute of Medicine, IOM, IOM HIT and Pateint Safety Report, Patient safety
By: Wendy Whittington, M.D., MMM, Chief Medical Officer, Anthelio Healthcare Solutions
Last week the Institute of Medicine (IOM) released its report on Health Information Technology and Patient Safety, Health IT and Patient Safety: Building Safer Systems for Better Care. This report reminded readers that past landmark reports, such as To Err is Human and Crossing the Quality Chasm, released over a decade ago, enlightened the entire nation that we have a big patient safety and health care quality problem, and it challenges consumers and industry leaders alike with a call to action for systemic improvement. The new report essentially says that some progress has been made, but not enough. Basically, we haven’t done a very good job at all and, in fact, in some settings, things are worse.
The report points out that while Health Information Technology (HIT) holds promise in improving patient safety, it may be part of the problem rather than the solution. There is a shortage of adequate studies to present solid facts, but the general consensus, according to the recent report is that things aren’t looking good.
The report encouraged a long overdue national discussion, but failed to bring up facts to dig into in the report. Realistically, the authors did the best they could with the information available. It highlighted the blatant problem that the method with which many health care organizations are installing HIT is haphazard and not systematic, which makes it very difficult to know what the facts are.
Many studies point to increased safety problems with HIT and some, largely around medication errors. The report attempts to guess the root of the problem but lacks viable data. Rather, it makes a number of recommendations.
While the HITECH Act meant well and while the antiquated paper-based way of doing things in health care wasn’t working, we need to ask a fundamental yet difficult question. Is it possible that the reason we are having such a hard time deciphering through the data is because we don’t have a coherent health care system? Most of us seem to agree that a missing piece in many of the systems being installed today is interoperability. The lack of a consistent method and way of doing things within our fractionated delivery system and a lack of interoperability presumably go hand in hand.
HIT is the foundation for health care reform, yet health care is allowing too much variability in the systems installed. Not to mention, a large vendor free-for-all in the market has been encouraged. The principles that we have set out to achieve – health care that is patient centric, prevention oriented, evidence-based, efficient and equitable — are often overlooked in the scramble to receive meaningful use dollars. Companies providing HIT are not enticed to play nice with others, and many times profit more when they are not easily interoperable with potential existing best of breed components.
With all of these disconnects, health care is in need of less variability in the systems installed, and more interoperability with a clear method for measuring outcomes. A reliable system needs to be set forth before those involved can collaborate for the greater good of patient care. If HIT is a platform for reform and a tool to improve quality of care and patient safety, health care professionals need to be playing the same game. Evidence-based medicine is important and minimizing variability in the practice improves quality and safety.
That said, why are health care professionals allowing so much variability in the way they implement HIT? As a start to the solution, the ONC should put more emphasis on standards, reducing variability and improving interoperability in HIT. The IOM report finds that the health care industry needs to do a better job at understanding what the problems are with regards to HIT and patient safety.
The report raised good questions, but not enough. The IOM should have been asking harder questions, such as:
- Would it have been more cost effective for the government to develop a uniform system that works and to provide it at no cost or at a cost that encourages extremely widespread adoption so that healthcare professionals can work uniformly and understand what they are actually working with?
- Are we spending the ARRA stimulus dollars effectively?
- Are we taking steps that will get us to healthcare that is patient centered, evidence-based and prevention oriented, efficient and equitable?
- Are we installing systems that will take us wisely into the future? Systems that will help us achieve population health under a revised system of reimbursement?
- Is it time to take a big deep breath and develop a plan that is going to work best for the dollars we have to spend?
Now there is something to think about!