“Lack of interoperability—preventing access to patient data from previous physician or other hospital visits—makes a mockery of a coordinated, patient-centered healthcare system,” says HIT researcher Ross Koppel, PhD, faculty member of University of Pennsylvania’s Sociology Department and School of Medicine.
Although Dr. Rogers acknowledges that HIT has the potential to revolutionize healthcare systems, boost quality and safety, and lower cost, he maintains that current HIT products fall short of those ambitious goals. “Vendors typically regard usability of their products as a convenience request by clinicians; any errors are regarded as training issues for physicians,” Dr. Rogers says. “But the way that data is presented on a screen matters—if it is difficult to input or retrieve data and leads to cognitive or process errors, that’s a product redesign issue for which vendors should be held accountable.”
Dr. Koppel says many HIT systems originated from billing system applications “and were not initially designed with the clinical perspective in mind. Hospitalists have to be particularly focused on usability of HIT systems when it comes to patient-safety impacts. They’re not the canary in the coal mine, they’re the miners—often the teachers guiding other clinicians on HIT use.”
SHM fully supports many of the IOM’s recommendations to improve the safety and functionality of HIT systems, including these as stated in an email to its members:
- Remove contractual restrictions, promote public reporting of safety issues, and put a system in place for independent investigations that drive patient-safety improvement.
- Establish standards and a common infrastructure for “interoperable” data exchange across systems.
- Create dual accountability between vendors and providers to address safety concerns that might require
- changes in an IT product’s functionality or design.
- Promote research on usability and human-factors design, safer implementation, and sociotechnical systems associated with HIT.
- Promote education of safety, quality, and reliability principles in design and implementation of HIT among all levels of the workforce, including frontline clinicians and staff, hospital IT, and quality teams—as well as IT vendors themselves.
There also are ongoing efforts in the private sector to improve HIT system functionality. For example, the HIMSS CDS Guidebook Series, of which Dr. Osheroff is lead editor and author and Dr. Rogers is a contributing author, is a respected repository of information synthesizing and vetting critical guidance for the effective implementation of clinical decision support (CDS).
“We’re also working with Greg Maynard [senior vice president of SHM’s Center for Hospital Innovation & Improvement] to use the collaborative’s tools to disseminate clinical-decision-support best practices for improving VTE prophylaxis rates,” Dr. Osheroff notes.
Hospitalists, as central players in quality improvement (QI), standardization, and care coordination, are natural choices as HIT champions, with valuable insight into how HIT systems should be customized to accommodate workflows and order sets in an optimal fashion, Dr. Rogers says.
“As critical as we are about the status of current HIT systems, we believe that systems can be designed more effectively to meet our needs,” he says. “By adopting many of the improvements enumerated in the IOM report, hospitalists are uniquely positioned to advance HIT to help achieve the goals of safer, higher-quality, and more efficient care.”
Christopher Guadagnino is a freelance writer based in Philadelphia.