{"id":5132,"date":"2010-03-16T22:29:26","date_gmt":"2010-03-17T03:29:26","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=5132"},"modified":"2010-03-16T22:35:07","modified_gmt":"2010-03-17T03:35:07","slug":"second-wave-of-comments-on-health-it-safety-issues","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/03\/second-wave-of-comments-on-health-it-safety-issues.html","title":{"rendered":"Second wave of comments on Health IT safety issues"},"content":{"rendered":"<p>Last month I <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2010\/02\/testimony-submitted-to-the-adoptioncertification-workgroup-for-its-feb-25-meeting.html\" target=\"_blank\">posted<\/a> the testimony I submitted to the Adoption\/Certification Workgroup of the Health IT Policy Committee. (I urge interested parties to review the links to other resources in that post.) Today Paul Egerman, chair of that team, circulated a preliminary draft of recommendations from that meeting.  Here is my response tonight, edited a bit for clarity.<br \/>\n<!--more--><\/p>\n<p>My original testimony urged a policy of letting  patients see their records essentially on demand, not within 30-60 days  as currently allowed by HIPAA. To encourage that, I also recommend that we mandate amnesty for errors that are found in the record. I believe no other path can lead rapidly to the goal I think we should all share: to produce better care for patients in hospitals <em>today<\/em>.<\/p>\n<p>Tonight&#8217;s follow-on:<br \/>\n__________<\/p>\n<p>Paul (and all),<\/p>\n<p>Above all, I urge that we be pragmatic. We have a  chance to make rules that will, or may not, make a difference in reality. In that spirit:<\/p>\n<ul>\n<li>Reinforcing today&#8217;s other mails, I think it&#8217;s vital  to underscore what Dr. Koppel&#8217;s webcast [<a href=\"http:\/\/real.welch.jhu.edu\/ramgen\/DHSI\/Dec182009.rm\" target=\"_blank\">RealPlayer video<\/a>] illustrated: all the potential hazards you listed, and especially the UI and arbitrary hard-coded workflow  rules, can get in the way of data quality.\n<ul>\n<li>To me it was sufficiently scary to realize that if a  system was programmed to require 40mg of something, it cannot cope with two 20mg  tablets.<\/li>\n<li>To patients in hospitals for the next several years,  it does no good to rant about this and demand change. As my mentor said, what  works is to manage it thoughtfully.<\/li>\n<\/ul>\n<\/li>\n<li>Regarding implementation &amp; training  deficiencies, I emphasize again that regardless of cause, <strong>what matters to patients is the gap<\/strong>:  being aware of it and doing everything we can to deal with it. Ranting won&#8217;t  solve it.<\/li>\n<li>Regarding 5, &#8220;patients can find errors&#8221; &#8211; I want to  be careful not to sound like patients are proofreaders for physicians. It might  be clearer as &#8220;patients can often spot errors&#8221; or some such.\n<ul>\n<li>As I said earlier, we cannot absolutely prevent  errors, but we can certainly minimize their impact.<\/li>\n<li>Thanks for noting my wish &#8220;Let our foremost commitment be: To do healthcare better. Let us work  together.&#8221;<\/li>\n<\/ul>\n<\/li>\n<li>I don&#8217;t think I see anything in this draft about amnesty for  discovered errors. (I see whistleblower but not amnesty.) Without this I don&#8217;t  think we have a prayer of the industry accepting this, do we?\n<ul>\n<li>In open item #6 I do see &#8220;relationship between incident  reporting and liability&#8221; but I don&#8217;t think that&#8217;s an open issue &#8211; I think it&#8217;s open and  shut. As I said on my cover page, &#8220;let us do what encourages improvement.&#8221;  Without amnesty, data transparency will be understandably feared by hospital  boards and staff.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Regarding the open issue of extending whistleblower protection to IT safety issues, I  cannot imagine an argument against this. <em>Lives are at stake. <\/em>Who will  stand against any policy that will improve our error rate?  I know some will,  but I think it&#8217;s time for both types of &#8220;victims&#8221; to stand up &#8211; and I mean both  the patients and the physicians who want better tools.  Because as I learn about  healthcare, increasingly I find physicians who are frustrated by things that  hamper getting their jobs done.<\/p>\n<p>Finally, this all seems especially current with  recent news on the patient safety front:<\/p>\n<ul>\n<li>Paul Levy&#8217;s blog yesterday <a href=\"http:\/\/runningahospital.blogspot.com\/2010\/03\/what-does-it-take-revisited.html\">noted<\/a> that last week the Lucian Leape Institute at the National Patient Safety  Foundation released <a href=\"http:\/\/www.npsf.org\/pr\/pressrel\/2010-03-10.php\">a  report<\/a> saying &#8220;medical schools and teaching  hospitals have not trained physicians to follow safe practices, analyze bad  outcomes, and work collaboratively in teams to redesign care processes to make  them safer.&#8221; How scary is that?<\/li>\n<li>Macarthur Fellowship recipient <a href=\"http:\/\/en.wikipedia.org\/wiki\/Peter_Pronovost\">Dr. Peter Pronovost<\/a>,  medical director of Quality &amp; Safety at Johns Hopkins, was in the Times last  week <a href=\"http:\/\/www.nytimes.com\/2010\/03\/09\/science\/09conv.html\">http:\/\/www.nytimes.com\/2010\/03\/09\/science\/09conv.html<\/a>,  talking about how arrogance and ego get in the way of adopting methods that have  worked in other industries. That&#8217;s a <em>huge <\/em>red flag for health  IT.\n<ul>\n<li>Pronovost is the author of the checklist approach  that has massively reduced central line infections. As someone who&#8217;s had 28 days  of central line insertions, I&#8217;m grateful. Yet most hospital still resist this  simple, no-cost improvement.<\/li>\n<li><em>Business Week <\/em><a href=\"http:\/\/www.businessweek.com\/managing\/content\/jan2008\/ca20080115_768325.htm?chan=careers_managing+index+page_managing+your+career\">noted<\/a> that reasons for this failure include &#8220;Many physicians do not like being  monitored by nurses or otherwise being forced to follow a checklist&#8221; and &#8220;A wish  to avoid standardized tasks and bureaucracy.&#8221;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Ironically, this all leads me to think that  healthcare is too important to be left in the unconstrained hands of the  healthcare industry.<\/p>\n<p>For our own sake, we need to provide guardrails. And the least expensive, most motivated force we  can introduce is the patient\/family&#8217;s eyes, double-checking what&#8217;s in the  record.<br \/>\nToday. We don&#8217;t need to wait  years.<\/p>\n<p>&#8220;The fundamental problem with the quality of  American medicine,&#8221; Pronovost said, &#8220;is that we\u2019ve failed to view delivery of health care as a  science.&#8221; Last week in the quality improvement retreat I  attended at Beth Israel Deaconess, a resident nailed it: &#8220;Boy, if we&#8217;re  neglecting useful knowledge from other professions, that&#8217;s  unscientific.&#8221;<\/p>\n<p>Thank you again for the opportunity to participate.  We can do great things.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Last month I posted the testimony I submitted to the Adoption\/Certification Workgroup of the Health IT Policy Committee. 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