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“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

-Sir Liam Donaldson

OBJECTIVES

  • Discuss challenges that have led to increased scrutiny of electronic health record (EHR) safety.

  • Discuss the key areas of focus for healthcare IT safety work by the Office of the National Coordinator for Health IT.

  • Identify resources and tools available for informatics specialists to use in the improvement of safety using healthcare IT.

  • Describe the importance of a standard method for healthcare IT safety event reporting.

INTRODUCTION

Every organization should ask itself two questions in regards to their electronic health record (EHR). First, is the EHR optimized to improve the safety of care delivery? In other words, have you taken advantage of the capabilities that an electronic record provides to improve patient safety that was just not possible with pen-and-paper records? And second, is the EHR safe to use? In other words, can you blame your EHR for errors or mistakes made in the healthcare setting? This second question has caused much discussion and even some controversy in recent years and will be the focus of this chapter on health information technology (IT) and patient safety.

Since the Institute of Medicine (IOM) report To Err is Human was published in 1999, patient safety has been on the healthcare agenda more than ever before (Kohn, Corrigan, & Donaldson, 1999). Those of us on the front lines of patient care may not have been as surprised as to the general public about the volume of errors reported in our healthcare organizations, because healthcare is complex, and care delivery is multifaceted and nonlinear, and can be a perfect set up for errors. If you consider the number of people, disciplines, and times a patient is “touched” literally and figuratively in some way during a healthcare encounter, it is a wonder that the reported errors are not higher. Enter the EHR. Will this be the answer to reduce medical errors and improve the quality and safety of care that we deliver to our patients?

Adoption of the EHR began back in the 1970s with relatively slow adoption until the signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 (Goolsby, 2002). The HITECH Act allocated more than $17 billion to stimulate the adoption of quality health IT systems or EHRs that demonstrate meaningful use as defined by the Office of the National Coordinator (ONC) for Health Information Technology (U.S. Department of Health & Human Services [HHS], 2009). As an agency of the Department of Health and Human Services (HHS), the ONC launched the Meaningful Use program that provided the impetus and structure for organizations to adopt EHRs in a meaningful way. In a 2013 report to Congress on the progress of the program, the ONC reported that between 2011 and 2012, the percentage of ...

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