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Texas Doctors: Protect Patients by Creating EHR Oversight

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  • WHAT: Texas’ physician representatives to the American Medical Association (AMA) House of Delegates governing body will ask AMA to beef up oversight of electronic health records (EHRs), with the ultimate goal of improving patient safety. The delegation will urge passage of a resolution urging AMA to work with Congress to create a National Health Information Technology (IT) Safety Center to reduce EHR-related patient safety risks.
  • WHEN: June 11-15, 2016
  • WHERE: Hyatt Regency Chicago, Chicago, Ill.
    (Reporters: Please contact TMA media relations to set up a phone interview with a member of the Texas delegation attending the conference. See a list of Texas delegation doctors’ hometowns.)
  • WHO: Texas delegation attending the American Medical Association’s House of Delegates meeting
  • WHY: Doctors say patient safety is threatened because of a recent surge in EHR adoption — due to rapid technology changes imposed by the Centers for Medicare & Medicaid (CMS) meaningful use (MU) program — and inadequate oversight of identified risks. 

The problem, physicians say, is when an error as simple as a typo is written into the computer software physicians use, there is little oversight to catch that error, alert all physicians and other health professionals who use the software, and to ensure the software vendor fixes it.

Therefore, Texas AMA delegates say, the electronic health information physicians gather and use to treat their patients is at risk … and sometimes the patients are at risk, too. The Texas doctors’ proposed IT safety center would serve as a clearinghouse for all EHR safety-related incidents and “near-misses” in which no patient harm occurred but an error in the software exists. 

One example Matt Murray, MD, chair of the TMA Ad Hoc Health IT Committee, cites is a situation where instructions for a child’s insulin dosing were entered correctly into EHR discharge instructions, but the EHR’s printed patient instructions had a decimal point error, suggesting a dosage 10 times higher than required. A nurse noticed the error, corrected it manually, and reported the near-miss to the EHR vendor, which then corrected the technical problem. However, the software vendor didn’t plan to warn other physicians nationwide because no other doctor had reported such a problem. 

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“I envision that this resolution would lead to an entity that has the authority and influence to drive improvements in EHR usability and interoperability,” said Dr. Murray, “which are the two most significant impediments to effective and [gasp!] meaningful use of EHRs.”

Dr. Murray says passing the resolution could ease the pressure on physician practices that are required, under the CMS MU program, to adopt and EHR into their business models. In the past 10 years, EHR use by physician practices in Texas has increased exponentially to 70 percent according to surveys by TMA.

However, Texas physicians say EHR vendors have not been held accountable for poor usability problems and lack of interoperability among EHR systems — both of which are patient safety risks that physicians commonly encounter. The resolution would require EHR developers to report patient safety incidents and near-misses to the Health IT Safety Center.  

“Physicians are assuming a higher level of risk and accountability for computer programs, networks, and infrastructures that are increasingly used as tools to generate patient care actions and facilitate medical decisions,” said Dr. Murray. “Although health IT-related patient safety risks would best be managed through a shared accountability between physicians and EHR vendors, the vendors are not currently held accountable for patient safety.” 

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The resolution, one of hundreds AMA will consider at its meeting, recommends the proposed Health IT Safety Center:

  1. Accept reports of patient safety incidents involving EHRs and near-misses from EHR vendors similar to how transportation safety incidents must be reported to the National Transportation Safety Board;
  2. Collect, aggregate, and analyze reported EHR data;
  3. Investigate incidents involving patient harm, and require EHR vendors to make appropriate changes;
  4. Monitor EHR incidents and near-misses to identify trends and risks; and
  5. Coordinate with other agencies to develop and broadly disseminate educational information and tools that mitigate identified patient safety risks related to technology use. 

TMA is the largest state medical society in the nation, representing more than 49,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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