Health IT has tremendous potential to empower providers and patients by efficient and effective use of health information. HIT spans a range of technologies – from personal health records, mobile health applications, Patient Portals to Electronic Health Records and Practice Management Systems. Adoption of HIT had a mixed response from both ends. This was driven partly due to inertia against change and partly due to the development and maintenance cost related to software. It final required a push form the government to get things to roll but it was convinced of the benefits the industry was going to draw from its widespread implementation and usage. Monetary incentives were declared by the government for adoption of certified EHRs and upon meeting specific benchmarks, called Meaningful Use. The other major factors which influenced its adoption are a general increase in the society's reliance on information technology federal funding to support purchase of EHR systems and future penalties under the Affordable Care Act for the ones who do not use EHRs. This led to 75 percent of office-based physicians to adopted EHR systems as of 2012. However the concerns continue to exist and the primary ones relate to the cost of purchasing the system and the likely loss of productivity upon its usage. But the major concerns related to adoption of EHR have been the mistakes committed in its usage and its failing to take into account safety of patients.
As a response to numerous complaints which have come from various sources esp. front line providers, the US federal government has implemented a Health IT safety plan. The purpose of this plan is to ensure that only those electronic health records systems are permitted which have the required safety features. Also, the system designs are to be made in such a way that it reduces the chances of occurrence of certain types of common mistakes for e.g. in Computerized Physician Order Entries. All this is expected to result in better care and safety. The main problem however is also the inability to categorically identify the extent to which health IT may have caused or contributed to medical errors. The idea of using a common format is being mooted to allow stakeholders to report on problems. The template suggested provides common definitions that ensure consistency in the manner in which providers report events -in terms of their potential for harm. To enable easy implementation of this initiative the front line staffs are also being extended liability protections to expedite the process of collecting, aggregating and analyzing patient data to which they have access to. Educational materials are also being prepared for public sharing and provisions for trainings identified to ensure that the awareness factor is really high among providers to identify and investigate health IT related adverse events. It will also equip the to take corrective actions and required follow-ups.
In order to improve the use of EHRs and eliminate chances of errors, Office of the National Coordinator for Health Information Technology (ONC) has come up with a 10-point recommendation. Gist is as follows:
1. A schedule to be made for working with the private sector to assess the impact of health IT on patient safety.
2. Enable health IT developers to share information about health IT experiences
3. Provision to make public user experiences across vendors
4. Identify criteria to be used for assessing and monitoring the safe use of health IT
5. Make it mandatory for health IT developers to publicly register and list their products with the ONC
6. Health IT developers to be shared the risk management requirements viz-a-viz human factors, safety culture and usability.
7. Make it mandatory for Health IT developers to report health IT related adverse events such as deaths, serious injuries or unsafe conditions
8. Establishment of an independent federal entity for investigating patient safety deaths, serious injuries, or potentially unsafe conditions associated with health IT
9. Appointment of a secretary to monitor and report on health IT safety progress
10. Cross-disciplinary research to be done towards the use of health IT as part of a learning healthcare system
To ensure all this, healthcare software testing has to gear up and test all the facets of a healthcare system, be it patient enrollment or any other system, be it the UI or the performance of the application, be it the security or the layered architecture. That is the only way to reduce the occurrence of medical errors.
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Issues with EHR adoption and its Remedies