tag:blogger.com,1999:blog-9551150.post2765874847973602864..comments2024-03-28T01:27:23.408-04:00Comments on Health Care Renewal: A Significant Additional Observation on the PA Patient Safety Authority Report "The Role of the Electronic Health Record in Patient Safety Events" -- RiskRoy M. Poses MDhttp://www.blogger.com/profile/00497209843184497847noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-9551150.post-76593765589930295042012-12-21T08:54:57.061-05:002012-12-21T08:54:57.061-05:00Anonymous December 19, 2012 9:31:00 PM EST said......Anonymous December 19, 2012 9:31:00 PM EST said...<br /><br /><i>Several thousand near misses is five plus significant</i><br /><br />As I pointed out to the Authority, Ross Koppel, PhD, probably the most pre-eminent health IT issues expert in the world today, at the Feb. 25, 2010 ONC Policy Committee Adoption/Certification Workgroup on IT safety said: "We don't know 99 percent of the [InformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-46027388232717757202012-12-19T21:31:36.482-05:002012-12-19T21:31:36.482-05:00Indeed, there has been zero after market surveilla...Indeed, there has been zero after market surveillance of these devices. It may be shocking to some that they have been deployed at the behest of the US Government even though there has been no pre-market vetting for safety and efficacy, either. <br /><br />Several thousand near misses is five plus significant, especially considering the fact that most hospitals ignore Act 13 in Pa. I know of Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9551150.post-11815752975365589832012-12-19T16:49:45.901-05:002012-12-19T16:49:45.901-05:00Trevor3130 writes:
We don't know how to inter...Trevor3130 writes:<br /><br /><i>We don't know how to intervene unless there's better knowledge, acquired through honest & accurate surveillance, of those actual events that are essential to initiate a tragic outcome - like, the eye directs the hand to the wrong ampoule. In the IT setting, it could be the erroneous placement of a tick in a digital box that sets a cascade of InformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-23519392207419819912012-12-19T15:31:49.131-05:002012-12-19T15:31:49.131-05:00Scot, you've touched on a "life or death&...Scot, you've touched on a "life or death" matter here that will weigh heavily on Health IT.<br />I believe much more consideration needs to be given to the genesis & mechanisms of "mistakes" in health care. I mean, almost all errors are committed by a human hand, whether it's hitting the button to print the wrong medication, or the amputation of the wrong limb. Trevor3130https://www.blogger.com/profile/08148555743063226957noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-2043191396183836312012-12-19T12:30:14.286-05:002012-12-19T12:30:14.286-05:00Reed D. Gelzer, MD, MPH writres:
Anyone who views...Reed D. Gelzer, MD, MPH writres:<br /><br /><i>Anyone who views such clinical notes as credible for clinical decision making is taking (and making) risk.</i><br /><br />Agreed.<br /><br />In my view, any medical center that implements technology that permits such faulty documentation, and/or permits it to occur (for whatever reason, pecuniary advantage, simple neglect, etc.), is partly InformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-58894113523446442762012-12-19T11:59:34.661-05:002012-12-19T11:59:34.661-05:00Thank you Scot for your continuing attention to th...Thank you Scot for your continuing attention to these matters. <br /><br />One of the many neglected aspects of risk is the fact that EHRs have degraded the clinical utility of the narrative note, both in the accessibility and in the credibility of its content? What further risks and costs arise when it is apparent to a clinician that a narrative record has been manufactured, not rendered as aRDGelzernoreply@blogger.com