Unintended Health IT Consequences? Help is on the Way

Healthcare professionals dealing with the unintended consequences of electronic health record (EHR) implementation and other changes will soon have some new tools to assist them, two experts said at Friday’s AHIMA’s Health Information Integrity Summit in Chicago, IL.

A preview of these tools were offered in the  session “The Quest for Safety with the Good: Addressing Potential Unintended Consequences of HIT EHRs and HIEs,” presented by Kathy Kenyon, JD, MA, senior policy analyst at the Office of the National Coordinator for Health Information Technology (ONC) and Joan Ash, PhD, MBA, MLS, professor and vice chair in the department of medical informatics and clinical epidemiology at the Oregon Health & Science University’s School of Medicine.

Unintended consequences are events or reactions from the introduction of an innovation or new technology that are different from what was intended, Kenyon said. Healthcare professionals generally think of unintended consequences as being adverse reactions or mistakes, Ash added, but sometimes they are not undesirable—just surprises.

“I think AHIMA members are often on the front lines, because the unintended consequences often fall in your lap,” Kenyon said.

Advice from the Experts

The new tools are a result of an ONC project to study unintended consequences. As part of the project, ONC convened a technical expert panel and work groups on three topics: EHR, health information exchange (HIE), and consumer e-health.

The aim was to use research and expertise to identify benefits and goals for each topic, as well as unintended consequences. “You can’t understand unintended consequences unless you understand intended consequences,” Kenyon said.

The work groups also identified solutions and three phases of steps that organizations can take to mitigate the unintended consequences. For example, an unintended consequence of HIE is incomplete, inaccurate, or untimely data provided in an HIE.

The work group offered possible solutions in three phases:

  • Design phase – best practices for matching and robust standards
  • Implementation phase – checklist to ensure adherence to standards
  • Post-implementation phase – process to account for changes at sites and HIE

“For most of those strategies, HIM folks are going to be implementing these,” Kenyon said.
Kenyon said reports and full tools from the project will be publically available in the near future.

A SAFER Record

ONC has particularly focused on patient safety and funded a project through research company Westat to develop resources for proactive assessment of safety in EHR-based clinical work systems. “This is about HIT safety—bad stuff that can happen when you implement an EHR,” Ash said.

The project, Safety Assurance Factors for EHR Resilience (SAFER), identified safety issues and the need to develop tools to ensure the safe use of EHRs. The outcome, Ash said, will be a set of guides that can be used by the industry. 

The SAFER guides will focus on key error-prone processes and issues such as computerized physician order entry, clinical decision support, communication between providers, downtime, and other issues. Ash said the guides will be based on interviews with a broad mix of providers, large and small, across the country. The aim, she says, is “to develop truly useful guides based on best practices and interviews.”

The guides are expected to be completed in 2013.



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