The federal office in charge of a massive rollout of electronic health records has issued a plan aimed at making those systems safer by encouraging providers to report problems to patient safety organizations.
Though some in the field say it doesn't go far enough, others said the plan 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 in the United States but that may come with significant risks.
A year ago, the Institute of Medicine issued a report urging the federal government to do more to ensure the safety of electronic health records. It highlighted instances in which the systems were linked to patient injury, deaths, or 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.
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 the agency, but reporting by doctors and hospitals is completely voluntary.
"There was no evidence that a mandatory program was necessary," Jodi Daniel, the office's director of policy and planning, said in an interview.
The office has been under pressure to roll out the electronic health records systems quickly while protecting patient data and making sure that the systems don't 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 in the industry if it had opted instead to require the kinds of tests and review by the Food and Drug Administration that new medical devices and drugs must go through, he said. But some say the records systems need more 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.
Some developers require providers to sign nondisclosure agreements before using their systems, and the safety plan does not prohibit such gag clauses. While the plan addresses reporting of known problems, Koppel said it will not help researchers and developers understand problems that go unnoticed but that may be causing real patient harm.
"We only know the tip of the iceberg" about how electronic health records affect patient care, said Koppel, who was an official reviewer for the Institute of Medicine report.
Koppel said the mantra of the Office of the National Coordinator has been that more health IT leads to better health care. "It probably is better than paper," he said, "but it could be so much better than it is."
Ashish Jha, associate professor of health policy at Harvard School of Public Health and a member of the panel that drafted the Institute of Medicine report, said he wants doctors to be able to report problems -- errors in medication lists, for example -- in real-time so they can be found and fixed quickly. The safety plan does not require systems to have that capability, but Daniel said her office could soon add such a requirement for products that receive federal certification.
The bigger problem is that health care as a whole needs a better way of tracking patient safety, Jha said. Monitoring issues caused by electronic health records "should be a part of it, and then we can actually know if this is a small, medium or large contributor to patient safety issues," he said. "But we don't know that."