Article Proposes Framework for the Development of Electronic Health Record-Specific Patient Safety Goals

BACKGROUND:
Recent evidence has highlighted significant and often unexpected risks resulting from the use of electronic health records (EHRs) and other health information technology. These concerns are compounded by the extraordinary pace of EHR development and implementation; for example, the number of certified EHR vendors in the U.S. has increased from 60 to more than 1,000 since mid-2008. A coordinated, consistent, national strategy is needed to address the safety issues posed by EHRs, as well as improving healthcare safety in the context of technology use.

SUMMARY:
The authors suggest that clearer guidance is needed to align patient safety activities with those required for a safe EHR-enabled healthcare system. A set of EHR-specific safety goals, modeled after the Joint Commission's National Patient Safety Goals, may provide organizations with focus areas for sustained improvements in organizational infrastructure, processes, and culture as they adapt to new technology. To account for variation in stages of EHR implementation and levels of complexity across clinical practice settings, the authors propose a new three-phase framework for the development of EHR-specific patient safety goals:

• Phase 1: address safety concerns unique to technology (i.e. safer EHRs);
• Phase 2: mitigate safety concerns from failure to use technology appropriately (i.e. safer application and use of EHRs); and
• Phase 3: stimulate the use of technology in order to monitor and improve patient safety (i.e. leveraging EHRs to facilitate oversight and improvement of patient safety).

The authors suggest that this approach requires urgent prioritization given the rapid pace of EHR adoption and resulting changes in our nation's healthcare system. Input on these goals must be sought not only from EHR developers and clinical end-users, but also from clinicians, cognitive scientists, human factors engineers, graphic designers, and informaticians with expertise in patient safety in complex health care environments. Creating unique EHR-related national patient safety goals will provide new momentum for patient safety initiatives in an EHR-enabled healthcare system.

AUTHOR/FUNDING INFORMATION:
Dr. Singh is part of HSR&D's Houston Center for Quality of Care and Utilization Studies and the Director of the Houston VA Patient Safety Center of Inquiry funded by the VA NCPS.

Sittig DF and Singh H. Electronic Health Records and National Patient Safety Goals. The New England Journal of Medicine, “Sounding Board” article. November 8, 2012;367(19):1854-60.