White Coat Notes

A push for safe e-health records

Excerpts from the Globe’s health care blog.

The federal office in charge of a massive rollout of electronic health records hasa planto make those systems safer by encouraging providers to report problems to patient safety organizations.

Though some say the plan doesn’t go far enough, others say it is an important step for an office whose primary role has been cheerleader for a technology that has the potential to dramatically improve health care — but which may come with significant risks.

A year ago, an Institute of Medicine report urged the government to do more to ensure the safety of electronic health records. It highlighted instances in which the systems were linked to injury, death, and other unsafe conditions.


The report suggested creating an independent body to investigate problems with electronic records and to recommend fixes, similar to how the National Transportation Safety Board investigates aviation accidents.

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Instead, the Office of the National Coordinator for Health Information Technology delegated various monitoring and data-collection duties to existing federal offices, including the Agency for Healthcare Research and Quality. The office has asked patient safety organizations, which work with doctors and hospitals to monitor and analyze medical errors, to add health IT to their agendas. Data from the organizations would be aggregated by the agency, but reporting by doctors and hospitals would be voluntary.

“There was no evidence that a mandatory program was necessary,” said Jodi Daniel, the office’s director of policy and planning.

The office has been under pressure to roll out electronic records systems quickly, while protecting patient data and making sure that the systems do not cause problems in medical care, said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center.

“It’s this challenging chicken-and-egg problem,” he said. The plan, which is subject to public comment through Feb. 4, “is a reasonable start,” in part because it puts more pressure on hospitals and doctors to monitor safety, Halamka said.


The government would have risked stifling innovation if it had opted to require the kinds of tests and review by the Food and Drug Administration that new medical devices and drugs go through, he said. But some say records systems need intensive review.

There is little good research into how the systems improve health care, and there are big obstacles to fixing even the known problems, said Ross Koppel, a professor of sociology at the University of Pennsylvania who studies hospital culture and medication errors.

The plan addresses reporting of known problems, Koppel said, but will not help researchers and developers understand problems that go unnoticed but cause real patient harm. “We only know the tip of the iceberg” about how electronic records affect care, Koppel said.

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