By Michael Bologna
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
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
“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