Thursday, December 09, 2010

ECRI: Healthcare IT In Top Ten Health Technology Threats to Patient Safety

Number 5, that is.

The ECRI Institute is an independent, unbiased, evidence-based healthcare research, information, and advice provider. They have been in operation for more than 40 years and are one of only a handful of organizations designated as both a Collaborating Center of the World Health Organization and an Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality.

I've cited their code of ethics at HC Renewal as a model of commendable healthcare conduct before:

Conflict of Interest - The Integrity of Independence

Remaining unbiased is difficult, if not impossible, when conflicts of interest are present. That is why we strictly enforce our conflict-of-interest rules and have carefully developed an environment that maximizes objectivity, productivity, and integrity of process.

We accept no grants, gifts, finder’s fees, or consulting projects from, and our employees are not permitted to own stock shares in, medical device or pharmaceutical firms. To make sure that is the case, we examine each employee’s federal income tax return after it is filed.

And, we accept no advertising revenues from any source.


(Full disclosure: I was a contributor on health IT issues to their 2008 book "Physician Office Fundamentals in Risk Management and Patient Safety.")

ECRI's most recent report is "The Top Ten Health Technology Threats to Patient Safety" for 2011 available at this link. Their Dec. 7 press announcement is here.

I'd mentioned an earlier edition of the report at my Sept 2010 post "Health IT: Danger" as was spoken about by Dr. Ross Koppel at Univ. of PA, but will present more detail here now that the 2011 report is available to the public.

I am citing the WSJ health blog on this report, as ECRI requests linking to their registration and downloading page for the full report, rather than direct dissemination, posting, or republishing of this work, without prior written permission:

December 8, 2010, 6:15 PM ET
The Top Ten Health Technology Threats to Patient Safety
WSJ Health Blog

By Katherine Hobson

For the fourth year running, the nonprofit ECRI Institute has put together a list of what it judges to be the top ten health technology hazards on which health-care facilities should focus their efforts.

The list in descending order of importance, doesn’t necessarily reflect the devices or problems with the most reported errors. That’s a factor, but so is “the severity of the problem, whether or not there’s a way to fix or mitigate the problem, and the high-profile” nature of the problem, Jim Keller, vice president for health technology evaluation and safety at ECRI, tells the Health Blog.

Among risks such as radiation therapy overdose and other dosing errors (#1), alarm hazards (#2), cross-contamination from flexible endoscopes (#3), high radiation dose of CT scans (#4), and luer misconnections (#6, misconnections of various infusion tubes), there's this:

#5 Data loss, system incompatibilities and other health IT complications: Problems with electronic-health records and other health IT systems can lead to problems including lost data, the need for repeat testing and even patient injury or death.

Then another obvious concern is raised:

While Keller says both he and ECRI support the push for digitized systems, the rush for federal incentives raises “concern that some of the kind of problems we are describing will be overlooked.”

It's not a "concern" to me, it's a fact.

So, here we have it:

An independent, nonprofit organization that for more than 40 years has been dedicated to bringing the discipline of applied scientific research to discover which medical procedures, devices, drugs, and processes are best, with unique ability to marry practical experience and uncompromising independence with the thoroughness and objectivity of evidence-based research, reports:

"Problems with electronic-health records and other health IT systems can lead to problems including lost data, the need for repeat testing and even patient injury or death."

The degree of risk is unknown (cf.:
Joint Commission 2009 Sentinel Event Alert on Health IT Safety, PDF):

"There is a dearth of data on the incidence of adverse events directly caused by HIT overall."

This does not seem the best environment for the ethical, rapid diffusion of this technology
nationwide, under penalty of loss of income and loss of Board Certification and even licensure for non-adopters.


For those of different ethics than ECRI, health IT is a literal cornucopia.

Addendum:

I note this comment from a nurse at the WSJ health blog story's comment section:
8:50 am December 9, 2010

The list was predictable, emanating from my observations as a registered nurse. It has become impossible to give patients care that they need. Corners are cut. It is easier for doctors to order scans than it is to examine patients. I would rather examine patients but the hospital requires that I click everything in to the electronic record, and [t]hat takes a long time. The reference to the CPOE is true. It is a nightmare because of the mistakes it promotes and it intereferes with communication disrupting my team’s care of the patient.

This must be one of those "anecdotal" reports that constitute a growing corpus of irrelevant "anecdotes", to be safely ignored because they were not obtained as part of a scientific experiment.

-- SS

Addendum Dec. 10, 2010:

From an earlier post of mine (of which I was reminded via a viewing from IP 150.148.0.#, FDA.gov, on a Google search on "health IT safety" this morning), we don't need to worry about HIT risks. ONC chair David Blumenthal said so:

... [Blumenthal's] department is confident that its mission remains unchanged in trying to push all healthcare establishments to adopt EMRs as a standard practice. "The [ONC] committee [investigating FDA reports of HIT endangement] said that nothing it had found would give them any pause that a policy of introducing EMR's could impede patient safety," he said.

-- SS

3 comments:

Anonymous said...

The fraud on the American people continues, enriching the vendors of defective HIT systems while killing off the citizens prematurely, with the untested instrumentation promoted by the Government.

Scot M Silverstein MD said...

Anonymous said...

The fraud on the American people continues, enriching the vendors of defective HIT systems while killing off the citizens prematurely

At the organizational level, the problem is two sided: there are the producers, and the consumers, of this technology.

I agree that IT personnel are usually lacking in medical knowledge, but I've seen too many hospital clinician IT leaders who are just as deficient in informatics & computer knowledge [the two are different] and experience. Both sides are healthcare IT amateurs, in other words, and mismanagement of healthcare IT is the result.

I believe health IT can be done far better, but this will not occur in the near time frame via the actors and practices common in today's health IT ecosystem.

-- SS

healthcare technology said...

Thanks for a very informative article. I guess there should have been a careful evaluation of these medical devices prior to being used on people during certain procedures.