Initial Impressions from the IOM report: Health IT and Patient Safety: Building Safer Systems for Better Care

Despite some of the alarmist responses to the report, I want to assure anyone reading this that using better technology to improve healthcare is a necessity. Trying to pull back from adoption by saying that health IT has safety problems would be like saying that because there are automobile accidents we should ban cars. Health IT can improve patient safety and the quality of care we provide.

But a few things stand out from my first reading of the report. First is this:

"The current state of safety and health IT is not acceptable; specific actions are required to improve the safety of health IT. The first eight recommendations are intended to create conditions and incentives to encourage substantial industry-driven change without formal regulation. However, because the private sector to date has not taken sufficient action on its own, the committee believes a follow-up recommendation is needed to formally regulate health IT.

If the actions recommended to the private and public sectors are not effective as determined by the Secretary of HHS, the Secretary should direct the FDA to exercise all authorities to regulate health IT."

And then looking back at some of the recommendations, one that immediately caught my eye:

"The committee considered a number of potential organizations that could objectively analyze reports of unsafe conditions, as well as conduct investigations into health IT–related adverse events in the way the committee envisions, including the FDA, ONC, AHRQ, and the private sector. The committee concluded that investigating patient safety incidents does not match the internal expertise of any existing entity, as the needed functions are under the jurisdiction of multiple federal agencies and efforts are generally uncoordinated and not comprehensive.

The committee believes development of an independent, federal entity could perform the needed analytic and investigative functions in a transparent, nonpunitive manner. It would be similar in structure to the National Transportation Safety Board, an independent federal agency created by Congress to conduct safety investigations. The entity would make nonbinding recommendations to the Secretary of HHS. Nonbinding recommendations provide flexibility, allowing the Secretary, health care organizations, vendors, and external experts to collectively determine the best course forward."

And:

"Recommendation 8:

The Secretary of HHS should recommend that Congress establish an independent federal entity for investigating patient safety deaths, serious injuries, or potentially unsafe conditions associated with health IT. This entity should also monitor and analyze data and publicly report results of these activities."

We have been using an EHR for over seven years. There is no doubt that the quality of care has improved, that safety is increased, and ultimately costs are also lowered through the proper implementation of health IT. But it is this proper implementation that is so key, and sadly, sometimes so lacking.

I think the report is a solid start and I look forward to HHS action. I was happy to see +Farzad Mostashari's post today, which stated, "ONC will lead an HHS planning initiative to develop a comprehensive EHR safety action and surveillance plan well within the 12-month period recommended by IOM. In formulating this plan, ONC will work with the FDA, AHRQ, NIH, and CMS as well as the broader healthcare community and industry."

I have absolute confidence that the measured and thoughtful response by HHS to the issues raised in this report will help alleviate many of the concerns raised. But I also believe that it is our responsibility in the healthcare and technology communities to help make this happen...
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