Who Watches the Watchers

Summary

The rise in the use of electronic health records (EHRs) and associated resources over the last decade is leading to the end of the paper medical record and all the risks associated with the use of a paper chart. However, there has not been a concomitant creation of a systematic oversight body that is specifically charged with ensuring the public’s safety through the use of EHR knowledge resource tools or EHRs themselves. We recommend the formation a Health Information Technology Safety Center. Such a center could collect error reports, review EHRs and the knowledge resources incorporated within them, and investigate particularly challenging EHR-related safety issues at participating health care delivery organizations. Safety issues could be identified, corrected, and the solutions widely disseminated.

Citation: Labkoff SE, Sittig DF. Who watches the watchers: working towards safety for EHR knowledge resources. Appl Clin Inform 2017; 8: 680–685 https://doi.org/10.4338/ACI-2017-02-IE-0032

Human Subjects Protections

This editorial contains no patient data, therefore, it is not subject to Human Subject Research Approval

• References

• 1 Department of Health and Human Services. 45 CFR Part 170 RIN 0955-AA00 ONC Health IT Certification Program: Enhanced Oversight and Accountability. 19 October 2016 Available at: https://www.fed eralregister.gov/documents/2016/10/19/2016–24908/onc-health-it-certification-program-enhanced-oversight-and-accountability
• 2 The White House Office of the Press Secretary. Presidential Executive Order on Reducing Regulation and Controlling Regulatory Costs. January 30, 2017 Available at: https://www.whitehouse.gov/the-press-of fice/2017/01/30/presidential-executive-order-reducing-regulation-and-controlling
• 3 Office of the National Coordinator for Health Information Technology Website. Available at: https://dash-board.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008–2015.php Accessed 21 Nov, 2016
• 4 McEvoy DS, Sittig DF, Hickman TT, Aaron S, Ai A, Amato M, Bauer DW, Fraser GM, Harper J, Kennemer A, Krall MA, Lehmann CU, Malhotra S, Murphy DR, O’Kelley B, Samal L, Schreiber R, Singh H, Thomas EJ, Vartian CV, Westmorland J, McCoy AB, Wright A. Variation in high-priority drug-drug interaction alerts across institutions and electronic health records. J Am Med Inform Assoc. 2016 Aug 28. pii: ocw114. doi: 10.1093/jamia/ocw114.
• 5 Kizzier-Carnahan V, Artis KA, Mohan V, Gold JA. Frequency of Passive EHR Alerts in the ICU: Another Form of Alert Fatigue?. J Patient Saf. 2016 Jun 22.
• 6 Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D. Effect of clinical decision-support systems: a systematic review. Annals of internal medicine 2012; 157 (01) 29-43.
• 7 Magrabi F, Aarts J, Nohr C, Baker M, Harrison S, Pelayo S, Talmon J, Sittig DF, Coiera E. A comparative review of patient safety initiatives for national health information technology. Int J Med Inform. 2012 Dec 18. doi: pii: S1386–5056(12)00238–9. 10.1016/j.ijmedinf.2012.11.014.
• 8 FDASIA Health IT Report: Proposed Strategy and Recommendations for a Risk-Based Framework. 2014 ONC, FDA, FCC. Available at: https://www.healthit.gov/sites/default/files/fdasia_healthitreport_final.pdf Accessed 21 Nov, 2016.
• 9 United States. 112th Cong. 2cd sess. S. 3187 Washington: GPO, 2012. 3 January 2012. Available at: https://www.gpo.gov/fdsys/pkg/BILLS-112s3187enr/pdf/BILLS-112s3187enr.pdf
• 10 Health Information Technology Policy Comm.. Certification/Adoption Workgroup, Testimony Of Jeffrey Shuren, Director Of FDA’s Center For Devices And Radiological Health (25 February 2010). Available at: http://www.cchfreedom.org/pdfs/Health%20IT%20Deaths%20-%20FDA%20jeffrey%20Shuren.pdf Accessed 5 January 2014
• 11 Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006; 13: 547-556.
• 12 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14: 415-423.
• 13 Meeks DW, Smith MW, Taylor L, Sittig DF, Scott JM, Singh H. An analysis of electronic health record-related patient safety concerns. J Am Med Inform Assoc 2014; 21 (06) 1053-1059.
• 14 Myers RB, Jones SL, Sittig DF. Review of reported clinical information system adverse events in US Food and Drug Administration databases. Appl Clin Inform 2011; 2: 63-74.
• 15 Menon S, Singh H, Giardina T, Rayburn WL, Davis BP, Russo EM, Sittig DF. Safety Huddles to Proactively Identify and Address Electronic Health Record Safety. J Amer Med Inform Assoc. 2017 (in press).
• 16 Randhawa AS, Babalola O, Henney Z, Miller M, Nelson T, Oza M, Patel C, Randhawa AS, Riley J, Snyder S. So SA collaborative assessment among 11 pharmaceutical companies of misinformation in commonly used online drug information compendia. Ann Pharmacother 2016; 50 (Suppl. 05) 352-359.
• 17 Talwar S, Randhawa A, Dankiewicz E, Crudele N, Haddox DJ. Caveat emptor: Erroneous safety information about opioids in online drug-information compendia. J Opioid Manag 2016; 12 (04) 281-288.
• 18 Matthews-King A. GPs told to review patients at risk as IT error miscalculates CV score in thousands. Available at: http://www.pulsetoday.co.uk/your-practice/practice-topics/it/gps-told-to-review-patients-at-risk-as-it-error-miscalculates-cv-score-in-thousands/20031807.fullarticle Accessed 10 January, 2017
• 19 Request for Information-Clinical Decision Support. Available at: https://www.fbo.gov/utils/view?id=82b0a8b1777f3c11599787d28bc544e7 Accessed 13 January, 2017
• 20 Payne T, Corley S, Cullen T, Gandhi T, Harrington L, Kuperman G, Mattison J, McCallie DP, McDonald CJ, Tang P, Tierney W, Weaver C, Weir C, Zaroukian M. Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs. Available at: http://dx.doi.org/10.1093/jamia/ocv066ocv066 First published online: 28 May 2015
• 21 Wright A, Aaron S, Sittig DF. Testing electronic health records in the ,,production“ environment: an essential step in the journey to a safe and effective health care system. J Am Med Inform Assoc 2017; 24 (01) 188-192.
• 22 Wright A, Hickman TT, McEvoy D, Aaron S, Ai A, Andersen JM, Hussain S, Ramoni R, Fiskio J, Sittig DF, Bates DW. Analysis of clinical decision support system malfunctions: a case series and survey. J Am Med Inform Assoc 2016; 23 (06) 1068-1076.
• 23 Sittig DF, Ash JS, Singh H. The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records. Am J Manag Care 2014; 20 (05) 418-423.
• 24 “Health IT Safety Center Road Map.”. Available at: http://www.healthitsafety.org Accessed 11 December, 2016
• 25 Singh H, Classen DC, Sittig DF. Creating an oversight infrastructure for electronic health record-related patient safety hazards. J Patient Saf 2011; 7 (04) 169-174.