To err is human; EHRs must account for that, panelists say

Jacob Reider: We have not focused enough on the individual

To err is human, so when it comes to electronic health records, better technology is what’s needed to make the programs safer, panelists said Wednesday during Politico‘s Outside In kick-off event in the District of Columbia.

Currently, usability of the systems is “horrific,” Ross Koppel, Ph.D., of the University of Pennsylvania’s School of Medicine, said. Health technology has made healthcare better and safer, but Koppel wondered if it’s as good as it should be due to the cost and effort.

“Are we keeping track of the mistakes it enhances?” he said. “Are we making progress in making it better? And I think the answer to that is resoundingly ‘no.'”

Questions about the safety of EHRs–and who is responsible when things go wrong–were threaded throughout the hour-long discussion.

Professor Harold Thimbleby, who teaches computer science at Swansea University Wales, used the auto industry as an example of a place where user error has become more accepted. To improve safety for users, new technology like seat belts and more airbags are added.

Health IT needs to do the same with EHRs, he said.

“[Stuff] happens,” he said, “but with good technology, that doesn’t have to turn into a catastrophe … rather than blaming the nurses and that’s the end of the story, [mistakes] happen and the whole system needs fixing.”

Bernadette Loftus, associate executive director at Mid-Atlantic Permanente Medical Group, said at her organization, they are fortunate to have a good number of physicians who can write code and have thorough training in the underlying code of the EHR.

“We didn’t just buy an off-the-shelf product, we took that product and had tons of physicians and nurses who learned to write the code that tweaks it. And we tweak it all the time; we put through an upgrade a month,” she said.

Loftus reiterated later on the importance of a connection between the users of a system and those who can fix it, saying it’s the “key to ensuring everything is safe.”

Jacob Reider, M.D., chief strategy officer at Kyron and former Deputy National Coordinator for Health IT, also touched on the patient’s position.

“We have not focused enough on the individual … and when we talk about user-centered design and the clinician and the role of the clinician, we’re missing the patient, the individual, in that conversation,” he said.

“I think we have a great opportunity to think about what’s best for the individual, and if we use that as a valued principle, everything else actually falls into place.”

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