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Yearb Med Inform 2016; 25(01): 7-12
DOI: 10.15265/IY-2016-023
DOI: 10.15265/IY-2016-023
IMIA and Schattauer GmbH
New Unintended Adverse Consequences of Electronic Health Records
Weitere Informationen
Correspondence to:
Dean F. Sittig
University of Texas Health Science Center at Houston
School of Biomedical Informatics
and UT-Memorial Hermann Center for Health Care Quality
and Safety
Houston, Texas, USA
eMail: Dean.F.Sittig@uth.tmc.edu
Publikationsverlauf
10. November 2016
Publikationsdatum:
06. März 2018 (online)
Summary
Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display.
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Keywords
Electronic Health Records (EHRs) - usability - confidentiality - quality indicators - data display - medical informatics
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-
References
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Correspondence to:
Dean F. Sittig
University of Texas Health Science Center at Houston
School of Biomedical Informatics
and UT-Memorial Hermann Center for Health Care Quality
and Safety
Houston, Texas, USA
eMail: Dean.F.Sittig@uth.tmc.edu
-
References
- 1 France FR. eHealth in Belgium, a new “secure” federal network: role of patients, health professions and social security services. Int J Med Inform 2011; 80: e12-6.
- 2 Protti D, Johansen I. Widespread adoption of information technology in primary care physician offices in Denmark: a case study. Issue Brief (Commonw Fund) 2010; 80: 1-14. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Mar/1379_Protti_widespread_adoption_IT_primary_care_Denmark_intl_ib.pdf (Accessed 1/7/2015).
- 3 Australian Department of Health and Ageing (DoHA). HealthConnect Evaluation. 24 August 2009. Available: http://www.health.gov.au/internet/main/Publishing.nsf/Content/FAFD8FE-999704592CA257BF00020A8CF/$File/Health-Connect.pdf (Accessed 1/7/2016).
- 4 Price M, Singer A, Kim J. Adopting electronic medical records: are they just electronic paper records?. Can Fam Physician 2013; Jul 59 (07) e322-9.
- 5 Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R. et al. A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Aff (Millwood). 2012; Dec 31 (12) 2805-16.
- 6 House of Commons. Committee of Public Accounts. Department of Health. The National Programme for IT in the NHS. Twentieth report of session 2006-7. Report, together with formal minutes oral and written evidence. March 2007 http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf (Accessed 1/7/2016).
- 7 Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V. et al. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ 2011; Oct 17 343: d6054.
- 8 The American Recovery and Reinvestment Act of 2009. Public Law 111-5-February 17, 2009. Pg. 227 https://www.gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf (Accessed 22 Feb 2016).
- 9 Simborg DW, Detmer DE, Berner ES. The wave has finally broken: now what?. J Am Med Inform Assoc 2013; Jun 20 e1 e21-5.
- 10 Collen MF. General requirements for a Medical Information System (MIS). Comput Biomed Res 1970; Oct 5 3 (05) 393-406.
- 11 Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic Health Record-Related Events in Medical Malpractice Claims. J Patient Saf 2015 Nov 6.
- 12 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; Sep-Oct 13 (05) 547-56.
- 13 Rogers EM. Diffusion of Innovations, 5th Edition. Free Press; New York, NY: 2003
- 14 McDonald CJ, Tierney WM, Overhage JM, Martin DK, Wilson GA. The Regenstrief Medical Record System: 20 years of experience in hospitals, clinics, and neighborhood health centers. MD Comput 1992; Jul-Aug 9 (04) 206-17.
- 15 Gardner RM, Pryor TA, Warner HR. The HELP hospital information system: update 1998. Int J Med Inform 1999; Jun 54 (03) 169-82.
- 16 Miller RA, Waitman LR, Chen S, Rosenbloom ST. The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt. J Biomed Inform 2005; Dec 38 (06) 469-85.
- 17 Borst F, Appel R, Baud R, Ligier Y, Scherrer JR. Happy birthday DIOGENE: a hospital information system born 20 years ago. Int J Med Inform 1999; Jun 54 (03) 157-67.
- 18 Mennemeyer ST, Menachemi N, Rahurkar S, Ford EW. Impact of the HITECH act on physicians’ adoption of electronic health records. J Am Med Inform Assoc 2015 Jul 30. pii: ocv103.
- 19 Wright A, Ash JS, Erickson JL, Wasserman J, Bunce A, Stanescu A. et al. A qualitative study of the activities performed by people involved in clinical decision support: recommended practices for success. J Am Med Inform Assoc. 2014; MayJun 21 (03) 464-72.
- 20 Murphy DR, Reis B, Kadiyala H, Hirani K, Sittig DF, Khan MM. et al. Electronic health record-based messages to primary care providers: valuable information or just noise?. Arch Intern Med 2012; Feb 13 172 (03) 283-5.
- 21 Wright A, Sittig DF, Ash JS, Erickson JL, Hickman TT, Paterno M. et al. Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study. Int J Med Inform 2015; Nov 84 (11) 901-11.
- 22 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; May 20 (05) 418-23.
- 23 Powsner SM, Wyatt JC, Wright P. Opportunities for and challenges of computerisation. Lancet 1998; Nov 14 352 9140 1617-22.
- 24 Reeve J, Hosking R, Allinson Y. Personal electronic health records: the start of a journey. Aust Prescr 2013; 36: 70-3. http://www.australianprescriber.com/magazine/36/3/70/3 (Accessed 1/7/2015).
- 25 Office of the National Coordinator for Health IT (ONC). 2015 Report to Congress on Health Information Blocking. April 2015 Available at: https://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf (Accessed 12/23/15).
- 26 HL7 Version 2 Product Suite. Available at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=185 (Accessed 25 Feb 2016).
- 27 D’Amore JD, Mandel JC, Kreda DA, Swain A, Koromia GA, Sundareswaran S. et al. Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative. J Am Med Inform Assoc. 2014; Nov-Dec 21 (06) 1060-8.
- 28 Sittig DF, Wright A. What makes an EHR “open” or interoperable?. J Am Med Inform Assoc 2015; Sep 22 (05) 1099-101.
- 29 Feblowitz JC, Wright A, Singh H, Samal L, Sittig DF. Summarization of clinical information: a conceptual model. J Biomed Inform 2011; Aug 44 (04) 688-99.
- 30 Wang TD, Plaisant C, Shneiderman B, Spring N, Roseman D, Marchand G. et al. Temporal summaries: supporting temporal categorical searching, aggregation and comparison. IEEE Trans Vis Comput Graph 2009; Nov-Dec 15 (06) 1049-56.
- 31 American Medical Association.. Improving Care: Priorities to Improve Electronic Health Record Usability. Available at: https://www.aace.com/files/ehr-priorities.pdf (Accessed 12/23/15).
- 32 Payne TH, Corley S, Cullen TA, Gandhi TK, Harrington L, Kuperman GJ. et al. Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs. J Am Med Inform Assoc 2015; Sep 22 (05) 1102-10.
- 33 Zhang J, Walji M. editors. Better EHR: Usability, Workflow and Cognitive Support in Electronic Health Records. University of Texas School of Biomedical Informatics at Houston; TX: 2014
- 34 Mathews AW. Anthem: Hacked Database Included 78.8 Million People. The Wall Street Journal, February 24, 2015. Available at: http://www.wsj.com/articles/anthem-hacked-database-included-78-8-million-people-1424807364 (Accessed 12/23/2015).
- 35 Liebowitz M. Stolen laptop puts 30,000 Texas Cancer Center patients at risk. NBCNews.com June 6, 2012. Available at: http://www.nbcnews.com/id/48015851/ns/technology_and_science-security/t/stolen-laptop-puts-texas-cancer-center-patients-risk/ (Accessed 12/23/15).
- 36 Merrill M. Lost TRICARE backup tapes could expose nearly 5 million records. Government Health IT September 29, 2011 Available at: http://www.govhealthit.com/news/lost-tricare-backup-tapes-could-expose-nearly-5-million-records (Accessed 12/23/15).
- 37 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; May 20 (05) 418-23.
- 38 Radcliffe J. Hacking(Medical(Devices(for(-Fun(and(Insulin: Breaking the Human SCADA System. Black Hat Conference August 2011 Available at: https://media.blackhat.com/bh-us-11/Radcliffe/BH_US_11_Radcliffe_Hacking_Medical_Devices_WP.pdf (Accessed 1/4/2016).
- 39 Robertson J. Hackers Encrypt Health Records and Hold Data for Ransom. Bloomberg News. August 10, 2012 Available at: http://www.bloomberg.com/news/articles/2012-08-10/hackers-encrypt-health-records-and-hold-data-for-ransom Accessed 1/4/2016.
- 40 Eastwood B. How Boston Children’s Hospital Hit Back at Anonymous. CIO, Sep 15, 2014. Available at: http://www.cio.com/article/2682872/health-care/how-boston-childrens-hospital-hit-back-atanonymous.html.
- 41 Akinyele JA, Pagano MW, Green MD, Lehmann CU, Peterson ZN, Rubin AD. Securing electronic medical records using attribute-based encryption on mobile devices. In Proceedings of the 1st ACM workshop on Security and privacy in smartphones and mobile devices 2011 Oct 17 (pp. 75-86). ACM.
- 42 Schweitzer EJ. Reconciliation of the cloud computing model with US federal electronic health record regulations. J Am Med Inform Assoc 2012; Mar 1 19 (02) 161-5.
- 43 Kho AN, Cashy JP, Jackson KL, Pah AR, Goel S, Boehnke J. et al. Design and implementation of a privacy preserving electronic health record linkage tool in Chicago. J Am Med Inform Assoc 2015; Sep 22 (05) 1072-80.
- 44 Zhang R, Liu L. Security models and requirements for healthcare application clouds. InCloud Computing (CLOUD), 2010 IEEE 3rd International Conference on 2010 Jul 5 (pp. 268-275). IEEE;
- 45 Willison D. Privacy and the secondary use of data for health research: experience in Canada and suggested directions forward. J Health Serv Res Policy 2003; Jul 8 Suppl 1:S1: 17-23.
- 46 Safran C, Bloomrosen M, Hammond WE, Labkoff S, Markel-Fox S, Tang PC. et al; Expert Panel. Toward a national framework for the secondary use of health data: an American Medical Informatics Association White Paper. J Am Med Inform Assoc 2007; Jan-Feb 14 (01) 1-9.
- 47 Bowes WA 3rd. Progress and challenge in meeting meaningful use at an integrated delivery network. AMIA Annu Symp Proc 2011; 2011: 144-51.
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