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CHICAGO--The Office of the National Coordinator for Health Information Technology is developing a series of tools that will help providers avoid and mitigate negative unintended consequences associated with the adoption of electronic health record and health information exchange systems, a senior agency official said Nov. 9.
Kathy Kenyon, a senior policy analyst at ONC, said the government is developing resources that will help providers anticipate and prepare for unintended consequences before new technologies are implemented. The resources will include academic research, checklists, and best practice guides. Several of these tools will be available to providers in 2013.
Kenyon, speaking during the Health Information Integrity Summit sponsored by the American Health Information Management Association (AHIMA), described unintended consequences as “events or reactions arising from the introduction of an innovation, a new technology or a process that are not part of the intended purpose or goal.’’
Potential unintended consequences from the use of new technologies include: patient safety mistakes; gaps in HIT safety oversight; legal liabilities and business risks; lower levels of productivity; communication interruptions; and misalignment with state or federal HIT policy goals.
While EHRs and HIE technology hold great potential for improving the quality of health care and controlling cost, Kenyon said too few providers are prepared for the potentially negative consequences that could occur.
''Part of the reason we have these unintended consequences is because most organizations have not been doing what you have been talking about in your organization,’’ Kenyon told AHIMA members. “We have not had the kind of upfront governance, coordination and data stewardship at the beginning. Often these unintended consequences are the result of inadequate planning at the beginning.’’
In 2010 ONC launched several efforts to help providers anticipate unintended consequences, Kenyon said. The agency deployed a technical expert panel to research the issue. ONC also convened three working groups that will address EHRs, HIE, and consumer e-health. The working groups will define the potential problems in these three areas and identify solutions and best practices linked to various technology implementation phases.
Kenyon said final reports from the work groups will be available on ONC's website during 2013.
She also pointed to ONC's Safety Assurance Factors for EHR Resilience (SAFER) project, which is specifically focused on patient safety issues. She said the SAFER research team is developing checklists and best practices tools that can be used by providers operating in a wide range of clinical settings.
Joan Ash, vice chair in the department of medical informatics and clinical epidemiology at the Oregon Health & Science University's School of Medicine and director of the SAFER research team, said the project is currently examining issues that could impact patient safety when new systems are deployed.
She said several site visits and data collection strategies will help the SAFER team understand the processes being used by the most proactive providers in the country.
Ash said the effort will eventually yield self-assessment and audit tools on a wide range of HIT issues. Some of the focus areas will include: computerized provider order entry (CPOE); electronic prescribing; system-to-system interfaces; patient identification; provider communication during transitions of care; laboratory results review processes; and management of emergencies and downtime events.
“This is about HIT safety,’’ Ash said. “This is not about patient safety in general. This is about the bad stuff that can happen when you implement EHR or any clinical information system. So we are trying to do something about this and provide some help to organizations moving into this through a series of self-assessment guides.’’
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