Improving the safety of health information technology requires shared responsibility: It is time we all step up

Abstract

In 2011, an Institute of Medicine report on health information technology (IT) and patient safety highlighted that building health-IT for safer use is a shared responsibility between key stakeholders including: "vendors, care providers, healthcare organizations, health-IT departments, and public and private agencies". Use of electronic health records (EHRs) involves all these stakeholders, but they often have conflicting priorities and requirements. Since 2011, the concept of shared responsibility has gained little traction and EHR developers and users continue to attribute the substantial, long list of problems to each other. In this article, we discuss how these key stakeholders have complementary roles in improving EHR safety and must share responsibility to improve the current state of EHR use. We use real-world safety examples and outline a comprehensive shared responsibility approach to help guide development of future rules, regulations, and standards for EHR usability, interoperability and security as outlined in the 21st Century Cures Act. This approach clearly defines the responsibilities of each party and helps create appropriate measures for success. National and international policymakers must facilitate the local organizational and socio-political climate to stimulate the adoption of shared responsibility principles. When all major stakeholders are sharing responsibility, we will be more likely to usher in a new age of progress and innovation related to health IT.

Current challenges in health information technology–related patient safety

“…While recent evidence from in-patient settings shows that health IT can make care safer, 4,5 it can also create new safety issues, some manifesting long after technology has been implemented. 6,7 Looking at this issue more deeply, it is clear that safe and effective design, development, implementation, and use of various forms of health IT require shared responsibility 8 and a sociotechnical approach (i.e. focus on the people, processes, environment, and technology involved).…”

How can we partner with electronic health record vendors on the complex journey to safer health care?

“…If we are to achieve the full potential of the EHR-enabled health care system, we must develop the trust and respect between HCOs and EHR vendors that is required to carry on meaningful, two-way relationships, based on shared responsibility. 24 Our analysis suggests that while the EHR Developer Code of Conduct 25 is a good start, further improvements in safety are likely to occur only with close partnership with vendors on the eight thematic areas we identified in our work. Within these areas, defining specific roles and responsibilities for vendors could achieve a shared understanding of how to achieve safer and more effective EHR-enabled health care.…”

The Effect of Electronic Health Record Usability Redesign on Annual Screening Rates in an Ambulatory Setting

“…Health care organizations, providers, and vendors together all share responsibility for improving EHR usability and must collaborate in finding solutions that meet the needs of patients and providers. 8 Health care systems regularly make configuration decisions that affect usability, including decisions as simple as naming laboratory tests or ordering items in dropdown lists. Some, particularly smaller health care systems with more limited resources, may be challenged to employ UCD processes or perform the type of usability testing used in this project.…”