Psychologists say people don’t research problems to find solutions, but rather to support the solution they’ve already decided upon. To cite a recent political example, many said the Bush administration “cherry picked” intelligence to foster support for a war it was already committed to. In addition to the selection side, this type of analysis entails ignoring or discounting information that casts doubt upon the intended course.
I fear that the Office of the National Coordinator (ONC) — the newly minted federal agency overseeing the implementation of the HITECH legislation — can no longer be relied upon to objectively evaluate and respond to the growing concerns that EMRs, in their current state of sophistication, bring with them as many patient safety risks as improvements. How can the agency legislatively tasked with forcing EMRs and CPOE into the nation’s healthcare system turn around and say it now appears those systems are actually dangerous?
Mind you, I mean “dangerous” in the sense that a gun is dangerous in the hands of someone who has never been trained to use it or, put more appropriately, dangerous in the hands of someone who’s only been given one afternoon of training. And that’s exactly what HITECH is doing to the healthcare industry — forcing systems with the potential lethality of guns into the hands of individuals who will not have had enough training to use them safely.
Rather than commissioning studies on EHR safety before it essentially made them a federal requirement, Congress took the word of powerful HIT lobbying organizations and stuffed the politically palatable HITECH provision into the bloated American Recovery and Reinvestment Act spending frenzy. Only now do we see the industry starting the kinds of studies that will reveal if EHRs are really ready for primetime. And even if they are found safe in the abstract, there is no way they can be safely deployed under the current HITECH timelines.
I’ve been talking to people about HITECH since it was passed early last year, and I am more convinced than ever that this legislation, and the way it is being implemented, is nothing short of irresponsible. The only way my opinion can be changed is if the Meaningful Use bar is dramatically lowered when the final regulations come out this summer.
Following a brief investigation by a Policy Committee workgroup which found no reason to slow ONC’s push to drive HITECH home, David Blumenthal, M.D., national coordinator, recently cited those findings as proof that HIT safety concerns were much ado about nothing. Blumenthal said any anti-EHR concerns were based on mere anecdotes and lacked the empirical evidence necessary to cause a change in policy. But empirical evidence doesn’t materialize out of thin air, and the kinds of studies that can produce it are just beginning.
For example, I recently interviewed Gordon Schiff, M.D., associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital. He is getting ready to head up an ambitious study on CPOE-related errors that should be completed in about a year.The study, funded by The National Patient Safety Foundation, will examine 200,000 reports of CPOE-related medical errors to elicit common themes and, hopefully, identify possible solutions.
It’s amazing to me that studies like this will just be finishing as the nation’s hospitals and physicians seeks to qualify for Stage 1 Meaningful Use incentive funds by practicing with the very technology being investigated. What will happen if the findings don’t jive with ONC’s mantra — that EMRs and CPOE are a necessary part of practicing medicine today. In fact, Blumenthal regularly makes the point that doctors who wish to consider themselves competent professionals had better get on a computer, and fast.
ONC wants to brush aside HIT safety concerns by saying the evidence of harm is all anecdotal, but studies that offer the empirical evidence ONC wants only get started after exactly such anecdotal smoke indicates fire. The problem with the current timeline is that by the time we find that fire, it may be too wild to contain.