COP associate dean contributes to IOM report on health information technology

After a year of research, an Institute of Medicine committee charged with studying the state of health information technology (HIT) in the U.S. published its report in November. Surprisingly, the committee found that HIT in some instances harms patients rather than helps them.

“We found evidence that health information technologies can, but don’t necessarily, improve patient safety,” says Phil Schneider, College of Pharmacy associate dean, who served on the committee. “And we also found a limited amount of information about the harm resulting from HIT.”

HIT includes systems such as computerized prescribing mechanisms and barcoding systems.

The report, “Health IT and Patient Safety: Building Safer Systems for Better Care,” was commissioned by the Department of Health and Human Services.

Key Findings
One key finding of the study was that HIT can improve patient safety in some areas such as medication safety; however, there are significant gaps in the literature regarding how health IT impacts patient safety overall.

According to Schneider, the committee was aware “of several anecdotal reports…where the clinical decision support [system] itself could have been considered the root cause of an error that wouldn’t have occurred” without the technology.

Overall, though, the findings on computerized prescriber-order-entry (CPOE) systems were inconclusive, as illustrated by an analysis of the adoption of the same CPOE system by different hospitals.

At one of the early-adopting hospitals described in the report, the CPOE system resulted in a "significant" increase in patient deaths, which were attributed to problems with planning for and implementing the system. A second early adopter learned from the mistakes of the first hospital and did not incur an increased death rate after deploying the CPOE system.

Other key findings included the fact that safer implementation and use begins with viewing HIT as part of a larger sociotechnical system, and that all stakeholders need to work together to improve patient safety.

Pharmacists’ Role
Schneider, who was the only pharmacist on the 18-member committee, emphasized that pharmacists should be aware of the report’s recommendations and participate in HIT development and adoption.

“Pharmacists need to be very involved in monitoring drug therapy, but they also need to be monitoring the processes within which drug therapy occurs,” he says. “Many of these health information technologies, particularly CPOE systems, substantially relate to medication use, and I think pharmacists should be pretty involved in the design of those systems, particularly the clinical decision support [systems].”

Conclusion
“I think what we’re going to see is a lot more scrutiny over health technologies both by the federal government and in the patient care setting,” says Schneider. “Individual hospitals are going to start to realize that this is a two-edged sword, and they need to be a lot more mindful about things.”

Find the full report, report brief and briefing slides at this Institute of Medicine website.

A summary of the report’s recommendations follows:

1. The Secretary of Health and Human Services (HHS) should publish an action and surveillance plan within 12 months that includes a schedule for working with the private sector to assess the impact of health IT on patient safety and minimizing the risk of its implementation and use.
2. The Secretary of HHS should ensure insofar as possible that HIT vendors support the free exchange of information about health IT experiences and issues and not prohibit sharing of such information.
3. The Office of the National Coordinator for Health IT should work with the private and public sectors to make comparative user experiences across vendors publicly available.
4. The Secretary of HHS should fund a new Health IT Safety Council to evaluate criteria for assessing and monitoring the safe use of health IT and the use of health IT to enhance safety.
5. All health IT vendors should be required to publicly register and list their products with ONC.
6. The Secretary of HHS should specify the quality and risk management process requirements that health IT vendors must adopt, with a particular focus on human factors, safety culture, and usability.
7. The Secretary of HHS should establish a mechanism for both vendors and users to report HIT–related deaths, serious injuries, or unsafe conditions.
8. The Secretary of HHS should recommend that Congress establish an independent federal entity for investigating patient safety deaths, serious injuries, or potentially unsafe conditions associated with health IT.
9. a.   The Secretary of HHS should monitor and publicly report on the progress of HIT safety annually beginning in 2012.
   b.   The Secretary should immediately direct the FDA to begin developing the necessary framework for regulation.
10. HHS, in collaboration with other research groups, should support cross-disciplinary research toward the use of health IT as part of a learning health care system. Products of this research should be used to inform the design, testing, and use of health IT.