New Report Envisions Key Role for Joint Commission in EHR Safety

Kerry Dooley Young

August 30, 2018

The widely followed Joint Commission could help spread the use of practices intended to make electronic health records (EHRs) safer by having its inspectors check on whether certain steps are taken, said the American Medical Association (AMA) in a new report done with the nonprofit Pew Charitable Trusts and hospital operator MedStar Health.

"The joint report has been introduced to the Joint Commission and we look forward to a conversation about the criteria," Michael Hodgkins, MD, MPH, the AMA's chief medical information officer, told  Medscape Medical News.

"While not all health care organizations receive Joint Commission accreditation, its program is influential and provides guidance for all organizations on how to improve safety," write the researchers of the report, Ways to Improve Electronic Health Record Safety .

An independent, nonprofit organization, the Joint Commission accredits and certifies almost 21,000 healthcare organizations and programs in the United States, according to its website. 

Joint Commission spokesperson Katie Bronk told Medscape Medical News that the group is currently reviewing the report "to determine if any of the recommendations are appropriate to consider for future accreditation or certification standards."

The report's authors said it could serve as "the foundation for a voluntary certification process for developers and EHR implementers."

In addition, the Office of the National Coordinator for Health Information Technology (ONC) could consider suggestions from the report as alternatives to its current requirements.

"However, given that these voluntary certification criteria include provisions that surpass those in federal regulations and address the entire life cycle and provider roles, such recognition by ONC is unlikely, though the agency could highlight private sector efforts," the report states.

"We appreciate the work that was put into the guide and agree that providers should take the time to make sure they implement their health [information technology (IT)] with an eye to the safe use of technology," an ONC spokesperson told Medscape Medical News in an emailed statement, referring to the report.

In developing the report and its recommendations, Pew, AMA, and MedStar Health's National Center for Human Factors in Healthcare conducted a literature review and convened a multidisciplinary expert panel composed of physicians, nurses, pharmacists, EHR vendors, patients, and health IT experts.

The federal government has provided more than $37 billion to promote use of EHRs in recent years. Still, these systems are frequently cited as a cause of frustration and burnout for physicians and other healthcare professionals, and can inadvertently put patients at risk. The report cited as an example of EHR risk the cases of laboratory tests displayed without the date and time of the results, which "could lead to clinical decisions based on outdated information." 

"And failures of systems to issue alerts about harmful medication interactions — situations that can stem from changes made by facilities, how clinicians enter data, or EHR design — could lead to medical errors," the report's authors write.

Recommendations

The Pew-AMA-MedStar report offers recommendations on steps that can help in keeping patients safe as health systems upgrade and modify their EHRs. These include establishing methods for personnel to report health IT-related safety hazards and permitting access for automated surveillance to detect misconfigurations.

The report also stresses a need to demand clear justifications and use cases when a healthcare system seeks to make customization within an EHR. Current federal testing processes do not address the circumstances in which customized changes are made to an EHR, the report states.

"Instead, current rules focus only on the design and development stage of the EHR," the researchers write. "While federal regulations mandate the testing of certain safety-related Features — such as medication-allergy checks — the requirements do not focus on whether those functions operate in a safe way."

The report also calls for having healthcare systems prioritize training by "making clear it's an institutional priority."

This would require releasing associates from normal duties to complete training and staggering training so that medical units are not staffed only with backup or less-familiar personnel. Training also should be tailored to the specific needs of the healthcare workers, according to the report.

For their part, developers of EHRs need to document the potentially high risks to patients from customizations that contradict developer guidance and communicate these perils to their clients, the researchers suggest. They also recommend that developers have dedicated personnel with credentials in patient safety and risk management on watch for potential issues and able to act on them.

Raj Ratwani, PhD, scientific director at the National Center for Human Factors in Healthcare at MedStar, said that the report differs from past EHR recommendations in its emphasis on shared responsibility. Past EHR examinations have tended to focus on the developers. But collaboration is needed between EHR developers and healthcare professionals for making the electronic records as safe as possible, he said.

"The provider organizations have a responsibility when it comes to product design and development. Their clinicians can be providing feedback on products to inform the next generation of technology that comes out," Ratwani told Medscape Medical News.

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