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Health IT safety is a shared responsibility

Author’s Note: Special thanks to the Allscripts User Experience Team for helping to develop this post.

Last month, the Pew Charitable Trusts, MedStar and the American Medical Association released Ways to Improve Electronic Health Record Safety. The report recommends rigorous testing and establishing voluntary criteria across the software life cycle to enhance the usability, safety and safe use of health information technology (IT). A quote from page one first acknowledges some of the benefits of electronic health records (EHRs):

“Electronic health records have transformed modern medicine, giving doctors and nurses better data to guide care, supporting enhanced patient safety through new automated tools, and creating more efficient processes by connecting different health systems.”

There are several studies and numerous examples of the benefits of health IT. Our clients successfully demonstrate these benefits, such as:

But the use of health IT has led to some unintended consequences. Regulatory, organizational, financial and quality requirements have increased health IT administrative tasks, such as documentation. These tasks can disrupt the clinician-patient relationship and add to growing clinician burdens.

Taking a systems approach

The report acknowledges the importance of the key attributes of a social-technical model for health IT, introduced by Dean Sitting, Ph.D., and Hardeep Singh, M.D., MPH. It contends that healthcare is a highly complex and adaptive system with multiple dimensions.

For example, there is the technology itself – the hardware, software, content and user interface. Then we add people who design, develop, implement, customize and ultimately use the technology. There are workflows and communication processes that are unique to each function and team. There are internal organizational policies, procedures and culture, as well as external rules, regulations and pressures.

These dimensions are not sequential or hierarchical, but rather they are interdependent. To achieve safety, usability and high reliability, a systems approach must address these interrelated factors that impact system safety.

Health IT safety is a shared responsibility of all stakeholders across the health IT lifecycle. It must be a top consideration throughout the software lifecycle – product design and development, implementation, customization and configuration, user training, and ongoing maintenance and upgrades.

Our commitment to usability and safety at Allscripts

Allscripts recognizes the role of health IT in improving usability and safety, and we commit to continue doing our part to minimize risks and unintended consequences.

The report authors advocate for the expanded use of existing best-practices for usability, beyond the minimum required by certification, including more robust clinical test cases. Allscripts agrees that usability criteria from The Office of the National Coordinator for Health Information Technology (ONC) sets a low bar, and we far exceed those expectations. Allscripts current usability and safety practices include deep user engagement, robust user-centered design (UCD) processes (e.g., formative testing) and rigorous clinical test cases.

In addition to comprehensive usability and safety practices during design and development, the authors also advocate for advanced testing with the customization, configuration and ongoing maintenance of health IT. This is important, because while configuration can bring benefits that are tailored to their organizations, it can also inadvertently introduce usability or safety concerns. Because of the potential for unintended consequences, it is critical for healthcare organizations to perform appropriate clinical risk assessment, as well as failure modes and effects analysis (FMEA) to ensure the safety of customizations.

EHR vendors should do more to explain and deliver to healthcare organizations the workflows that we know are safe and efficient, and we should make organizations aware of the impact of changes on safety and usability. EHR vendors should continue to make more of an effort to ensure our solutions consider safety modes when enabling configuration, or “guardrails” that can help to restrict known safety concerns.

As part of our commitment to achieving safety across the health IT lifecycle, Allscripts continues to participate with healthcare organizations, patient advocates, safety experts, researchers, patient safety organizations (PSOs) and other vendors to help ensure system safety.

EHR usability is just one piece of the healthcare socio-technical system. More user input and expanded testing will not by themselves be sufficient to make health IT products better. However, EHRs must continue to improve and we, as vendors, must help minimize potential risks to patient safety. It will take continued effort from multiple stakeholders to achieve this goal.

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