Eight-point framework designed to yield safer health care amidst greater EHR use

Researchers say stakeholders who follow their guidance can avoid unintended technology errors.

Health informatics researchers who developed an eight-point framework of key recommendations for safe electronic health record use contend it will assist various types of health providers and medical organizations in the safe adoption of these records.

Projections about the expected number of electronic health record (EHR) and electronic medical record (EMR) users have skyrocketed since the American Recovery and Reinvestment Act of 2009 provided financial incentives for using these systems, increasing the importance of focusing on patient safety during EHR implementation, the researchers said.

EMR and EHR systems both automate information typically contained in paper medical charts used in doctors’ offices. EHRs go one step further by providing the capability to interface with entities outside the medical office, including hospitals and other providers, payers, laboratories and imaging centers.

“With high-quality, well-designed, and carefully implemented systems, highly reliable, safe health care will be achieved,” Dean F. Sittig, PhD, stated in a press release.

Dean F. Sittig

Sittig, associate professor at the University of Texas School of Health Information Sciences at Houston, and Hardeep Singh, MD, MPH, assistant professor of medicine at the VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA and Baylor College of Medicine in Houston, collaborated to develop the eight-point framework for EMRs, which was published in the Journal of the American Medical Association.

Right to safety

“This framework can help make sure that EHRs are used safely and effectively as doctors continue to adopt them,” Singh, an internist, stated in the release.

The researchers said their framework provides an overall view of all the steps organizations must focus on to implement safe EHR systems and believe all eight of the following essentials, or rights, should be implemented.

“All these pieces interact with each other,” Sittig noted.

The “rights” are:

• Hardware and software: Before implementation, the organization needs the proper hardware and software. Without them, work flow and patient safety can be negatively impacted.
• Content: Content is as important as selecting the right system and EHR interface, but it can be beyond the orthopedic practice’s control, Singh said, noting that standardized vocabularies can avoid content-related EMR errors and facilitate information sharing.
• User interface: An effective user interface simplifies information entry and access, presenting important patient information in a way that allows clinicians to rapidly recognize and respond to problems.
• Personnel: For EHRs to work safely, health care organizations should hire trained or degreed software designers, developers, trainers and other staff with EHR knowledge and skills for implementation.
• Work flow and communication: The EHR system should be tested in the clinic or hospital before implementation so problems can be caught and corrected. Louis F. McIntyre, MD, whose practice implemented EMRs a few years ago, told Orthopedics Today, “Work flow changes are part of the downside of adopting an EMR in any setting.”
• Organizational characteristics: Systems to report errors and identify obstacles to care are essential. “Innovation, exploration and continual improvement are key organizational factors for safe EHR use,” Sittig and Singh noted in the release.
• State and federal rules and regulations: All rules and regulations that protect patient safety and privacy should be followed. EMRs can be made compliant with HIPPA and other regulations, McIntyre said.
• Monitoring: Continued oversight after initial EHR adoption and use is critical.

Hardeep Singh

Tough to implement

A study the researchers conducted into unintended consequences of adopting EHRs, from data entry errors to added work, helped in compiling these EHR rights.

“It was sort of a take-off on the five rights of safe medication usage,” Sittig told Orthopedics Today. “The point of our paper was that implementing EHRs is even more difficult than medication administration. The idea is you have to take into account all eight of these concepts when you implement and use these systems.” To get them all right while keeping an EHR system running effectively requires a monumental effort on the part of a health care delivery system or physician’s office, Sittig noted.

“I’m afraid some of these organizations may not be up to the task at this time, especially when these rights are not fully considered,” he said.

These rights apply to today’s EHR environment, but could easily change in the future, Sittig and Singh said.

“We are going to end up using this framework not just for studying EHRs, but more broadly for the study of all health care information technology,” Singh predicted.

For more information:

• Louis F. McIntyre, MD, can be reached at Westchester Orthopaedic Associates, 222 Westchester Ave., Suite 101, White Plains, NY 10604; 914-946-1010; e-mail: lfm@woapc.com.
• Hardeep Singh, MD, MPH, can be reached at VAMC, 2002 Holcombe Blvd., 152, Houston, TX 77030; 713-794-8601; e-mail: hardeeps@bcm.edu.
• Dean F. Sittig, PhD, can be reached at University of Texas, Memorial Hermann Center for Healthcare Quality and Safety, 6410 Fannin St., UTPB 1100.43, Houston, TX 77030; 713-500-7977; e-mail: dean.f.sittig@uth.tmc.edu. Singh and Sittig received support from the National Library of Medicine, VA National Center of Patient Safety, Houston VA Health Services Research and Development Center of Excellence and Agency for Health Care Research and Quality.

Reference:

• Sittig DF, Singh H. Eight rights of safe electronic health record use. J Amer Med Assoc. 2009;302:1111-1113.