Calls proliferate for creation of entity to investigate IT incidents the same way aviation and rail accidents are examined.


Aug. 5—Use of electronic health records (EHRs) among hospital-owned physician practices is trending toward universal adoption, but problems persist with interoperability and unplanned service disruptions, according to recent reports.

Meanwhile, calls are getting louder for a national entity to investigate health IT safety incidents—much like the National Transportation Safety Board looks into the root causes of airline and railroad accidents.

EHR adoption among hospital-owned practices is now around 92 percent, while freestanding practices have a 72 percent adoption rate, according to the HIMSS Analytics 2016 Outpatient PM & EHR Solution Essentials Brief.

These rates have helped physician practices position themselves to address broader patient needs and evolving regulations that will come with implementation of the Medicare Access and CHIP Reorganization Act (MACRA), according to the brief.

But, “there’s still a lot to do,” said Brendan FitzGerald, director of research at HIMSS Analytics.

FitzGerald noted that, while lagging behind hospital-owned practices, EHR adoption among independent practices has seen a dramatic increase since a rate of around 30 percent was reported in 2010. He sees EHRs helping physicians navigate new MACRA regulations, as well helping them find their way with advanced alternative payment models, accountable care organizations, and bundled payments.

The brief also noted that 15 percent of practices are planning a near-term purchase of a new system or replacement of their existing EHR.

But service can be interrupted. A U.S. Department of Health and Human Services (HHS) inspector general report found that 59 percent of hospitals reported an unplanned EHR interruption with about a quarter of those resulting in delays of patient care.

Nefarious Disruptions Still Rare

Though disruptions caused by cyberattacks and other nefarious actions have grabbed headlines, only 1 percent of the hospitals surveyed by HHS reported such an incident. The leading causes of disruptions were computer hardware malfunctions or failure, reported by 59 percent of the hospitals surveyed; internet connectivity problems, reported by 44 percent of the hospitals; and power failures, reported by 33 percent.

FitzGerald said he wasn’t surprised by these numbers.

“These organizations have been on a dramatic adoption kick and that takes a lot of infrastructure,” FitzGerald said. Adequate bandwidth or high-speed internet access has been a lingering issue for many hospitals, especially those in rural areas, FitzGerald noted.

Small, rural, and critical access hospitals also have problem with EHR interoperability, are less likely to electronically receive information from outside sources or providers, and their providers have lower rates of using information electronically received from outside their hospital system, according to a July data brief from the HHS Office of the National Coordinator for Health IT (ONC).  

One way to address these issues would be to create a National Health IT Safety Center, according to researchers Dean Sittig, PhD, and Hardeep Singh, MD, at the University of Texas-Memorial Hermann Center for Healthcare Quality and Safety in Houston. 

In a recent Health Affairs blog post, the pair noted that ONC’s 2017 budget request included $5 million to create such a center.  

Learning From Mistakes

Sittig and Singh envision the center as a public-private partnership that studies interruptions, cyberattacks, and other mishaps to find root causes of accidents or what vulnerabilities were exploited by hackers. The information would be disseminated to mitigate future problems.

“Every organization thinks it would never happen to them and, when it does, they’re shocked,” Sittig, a professor at the UTHealth School of Biomedical Informatics, said in an interview. “We shouldn’t be making the same mistakes twice and that would be a goal of the Safety Center: To learn from the mistakes of others.”

Sittig noted how the HHS inspector general’s findings matched those in 2013 report he co-wrote, which found that up to 20 percent of hospitals had a disruption lasting eight hours or longer.

A recent study published The BMJ compared patient mortality, readmissions, and safety events at 17 hospitals undergoing EHR implementation during 2011 to 2012 with 399 control hospitals in the same hospital referral region. Though there was concern that the disruptive nature of a “go-live” implementation period could interfere with clinical operations, researchers with the Harvard Medical School and Harvard’s Chan School of Public Health found no “overall negative association” between implementation and patient harm.

Sittig didn’t disagree with the findings, but said “patient harm” is often hard to measure.

“When you read the newspaper articles, the hospital spokesman says ‘No patients were harmed,’” Sittig said. “But, if you talk to the nurses, they say that patients didn’t get antibiotics for 12 hours. If you have a bad infection, 12 hours is a long time.”

The idea of a National Health IT Safety Center is not new. The concept was included in a 2014 strategy drafted by ONC, the Food and Drug Administration (FDA) and Federal Communications Commission (FCC). The idea was to “create a sustainable, integrated learning system for health IT safety to promote innovation and leverage and complement existing and ongoing safety initiatives.”

The cost was estimated at $17.8 million to $20.6 million for the first five years of operation with government funding being replaced by other revenue sources in later years.

AMA Action

In their blog post, Sitting and Singh noted the significance of having the American Medical Association House of Delegates approving a policy that endorses ONC’s efforts to create a National Health IT Safety Center.

“We applaud the AMA for taking a thoughtful and forward-looking position,” Sittig and Singh wrote.

The policy resolution was introduced by the Texas Medical Association and written by Matt Murray, MD, chair of the TMA’s Adhoc Health IT Committee.

“Our committee has been concerned about health IT safety hazards for many years,” Murray, a pediatric emergency medicine physician with the Cook Children’s Health Care System in Fort Worth, said in an interview. “What we kept coming back to was that this was not a state issue.”


Andis Robeznieks is a freelance writer based in Chicago. Follow Andis on Twitter at @AndisRobeznieks.

Publication Date: Friday, August 05, 2016