ONC’s First Health IT Safety Year: Progress Made and Challenges Ahead

Amy Helwig, M.D., M.S. and Judy Murphy, R.N. | September 18, 2014

We published the Health IT Safety and Surveillance Plan in July 2013 with the charge to learn, lead, and improve on health IT safety.

Since then, we have been busy implementing our Health IT Safety Program, which promotes the use of Health IT to improve the safety of health care and make sure that the health IT technology is used safely.  We also established our Office of Clinical Quality and Safety.

Over the past year we have learned more about electronic health records’ (EHRs) positive impact on the quality and safety of patient care which we share in our Health IT Safety Report. We also have a better understanding of the types of safety events related to health IT and, more importantly, the interventions available to prevent unintended consequences of the use of health IT tools.

The nation continues to make rapid progress in EHR adoption. Participation in the Medicare and Medicaid EHR Incentive Programs continues to accelerate. The share of hospitals that received an incentive payment increased more than 10 percent from June 2013 to June 2014, to 94 percent, and the share of professionals increased 56 percent from June 2013 to June 2014.

Meaningful use helps improve safety

Even more exciting is the impact we are seeing on quality and safety of health and care.  In January, an ONC-funded review by Rand Corporation of published studies from January 2010 through August 2013 — Health Information Technology:  An Updated Systematic Review With a Focus on Meaningful Use — found that health IT had statistically and clinically significant benefits, largely associated with the meaningful use functionalities of clinical decision support, computerized provider order entry, patient access, lists, and reminders.

Earlier this month, data from the 2013 National Ambulatory Medical Care Survey (NAMCS) of Physician Workflow similarly found that physicians using EHRs that met the meaningful use criteria were significantly more likely to report safety improvements associated with EHRs than physicians that were not using EHRs. Additionally, the majority of physicians using EHRs said their EHR facilitated direct communication with other providers and helped with referrals.

This new research also reported more about the role of EHRs in preventing medication adverse events, one of the most common type of patient safety events. Three times as many physicians reported that their EHR prevented a potential medication error than caused one. That finding is bolstered by a second study published in the summer of 2014 and funded by AHRQ that found Florida hospitals which adopted all five core measures of meaningful use for medication management in 2010 had the lowest rate of adverse drug events of all hospitals in the state.

Health IT safety lessons learned

Even with this progress on EHR adoption and the improvements in quality and safety, we realize that patient safety events related to health IT can still occur. To address this, we have learned more about health IT-related patient safety events, and the analysis we sponsored this past year (conducted by ECRI, UHC Safety Intelligence, and the Joint Commission) is consistent with earlier studies.

These new analyses show that the most common types of health IT-related events involve medications and most often involve data input or display errors, software configurations, and/or interfaces between systems.

Reports created using AHRQ’s Common Formats helped us learn that when these events occur, health IT is just one of many complex contributing factors. The events caused less harm and were considered more preventable than patient safety events not involving HIT.

These studies provide us with actionable information we can use to recommend interventions and resources on HealthIT.gov. We encourage you to review our recent postings such as: 1) Promoting Patient Safety through Effective Health Information Technology Risk Management; 2) A Guide: How to Identify and Address Unsafe Conditions associated with Health IT; 3) The Role of Health IT Developers in Improving Patient Safety in High Reliability Organizations; and 4) How Health IT Developers can work with a Patient Safety Organization.

ONC’s Health IT Safety Program continues to promote the safe use of Health IT.  This past January, ONC published nine Safety Assurance Factors for EHR Resilience (SAFER) Guides. These guides contain a total of 158 recommended practices in areas of recognized risk and are designed to help EHR users evaluate their own practices with regard to the safety of EHR technology itself, the safe use of EHRs, and continual monitoring and improvement.

We have emphasized safety enhanced design in our certification criteria, and are posting usability product testing results on the CHPL.  Our Health IT Policy Committee (HITPC) established a Safety Task Force to provide their comments on the draft report under the Food and Drug Administration Safety and Innovation Act, and we recently announced the formation of a new HITPC workgroup focused on Implementation, Usability and Safety.

Looking forward, we are building the foundation for a Health IT Safety Center. The Safety Center will engage private and public stakeholders by providing education on health IT safety, review studies on both the safety benefits of health IT as well as unintended safety events, and identify and promote interventions that will help to optimize the safe implementation and use of health IT.

We are excited about this process and encourage you to follow along as we build this new public-private partnership and look for ways to ensure that health IT is used safely.

Tell us about how health IT has helped you! Leave a comment below.