Health IT and Patient Safety: Building Safer Systems for Better Care
In their continuous efforts to improve health care, both the public and private sectors have invested—and continue to invest—heavily in health information technologies, collectively referred to as health IT. When designed and used appropriately, health IT is expected to help improve the performance of health professionals, reduce operational and administrative costs, and enhance patient safety.
However, some products have begun being associated with increased safety risks for patients. The Office of the National Coordinator for Health Information Technology (ONC), the unit within the Department of Health and Human Services (HHS) that is responsible for coordinating the development of a national health IT infrastructure and promoting the use of health IT, asked the Institute of Medicine (IOM) to evaluate safety concerns and to identify actions that both government and the private sector can take to alleviate those actions. The IOM appointed a study committee, which interpreted its charge as recommending ways to make patient care safer using health IT so that the nation will be in a better position to realize its potential benefits.
Critical Knowledge Gaps and Barriers
In its report, Health IT and Patient Safety: Building Safer Systems for Better Care, the committee examines the safety of health IT products and their effects on patient safety. Overall, the committee finds the literature about health IT and patient safety to be inconclusive. Some health IT applications are definitively successful at improving medication safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. But even in these instances, the ability to generalize the results across the health care system may be limited. For other products— including electronic health records, which are being employed with greater frequency— some studies find improvements in patient safety, while other studies find no effect.
More worrisome, some case reports suggest that poorly designed health IT can create new hazards in the already complex delivery of care. Although the magnitude of the risk associated with health IT is not known, some examples illustrate the concerns. Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death.
Fostering a Systems Approach
In looking for ways to make health IT–assisted care safer, it is important to recognize that the products are not used in isolation. Rather, they are part of a larger sociotechnical system that also includes people—such as clinicians or patients— organizations, processes, and the external environment. Safety emerges from the interactions of these factors. Comprehensive safety analyses, therefore, should not look for a single “root cause” of problems but should consider the system as a whole in looking for ways to reduce the likelihood that any given patient will experience an adverse health event.
Creating safer systems begins with usercentered design principles and includes adequate testing and quality assurance assessments conducted in actual or simulated clinical environments, or both. Designers and users of health IT should work together to develop, implement, optimize, and maintain health IT products. For most end users, an effective health IT product will provide easy retrieval of accurate, timely, and reliable data; incorporate simple and intuitive data displays; and yield evidence at the point of care to inform decisions. Among other improvements, the product will
- enhance workflow, perhaps by automating mundane tasks or streamlining work, without increasing physical or cognitive workloads;
- allow easy transfer of information to and from other organizations and providers; and
- cause no unanticipated downtime.