Building on several reports in recent years that focused on the intersection of health IT and patient safety, the Office of the National Coordinator for Health Information Technology (ONC) has released a roadmap for developing a national Health IT Safety Center.
The proposed center would focus on two main objectives: “using health IT to make care safer, and continuously improving the safety of health IT.”
Safety center would aim for ‘achieving safer care through collaboration’
Working with ONC, RTI International brought together a task force of health IT developers, clinicians and other insiders to help develop the roadmap. The projected cost of the center – which could begin with federal funding to a host organization – might range from $17.8 to $20.6 million over five years.
The planners did not propose a regulatory function for the center. Instead, its activities would include:
- Bringing together health IT stakeholders from the private and public sectors to exchange ideas.
- Identifying, testing and supporting the implementation of solutions for health IT concerns.
- Supporting health care providers regarding optimal IT usage.
Developers and vendors of health care IT products would play an important role in the center’s activities, as “Often they will be their customers’ best sources of information on the safety and safe use of health IT,” the authors wrote.
Many factors contribute to health IT safety
One of the publications the ONC cited in its roadmap was the Institute of Medicine’s “Health IT and Patient Safety: Building Safer Systems for Better Care” report from 2011. In it, the authors write that “In looking for ways to make health IT– assisted care safer, it is important to recognize that the products are not used in isolation. Rather, they are part of a larger sociotechnical system that also includes people — such as clinicians or patients — organizations, processes, and the external environment.” Safety requires optimum interactions between all these moving parts, and safety analyses “should not look for a single ‘root cause’ of problems,” the authors wrote.
At the Health Affairs Blog, Dean Sittig and Hardeep Singh asked: “Why hasn’t all of this [the activities of the proposed Safety Center] been done by now? The answer lies in the complexity of health IT use. In addition, research to understand unintended consequences of Health IT has emerged mostly in the last decade. As recognized in the roadmap, a comprehensive, sociotechnical approach is essential; this must include technical factors, as well as nontechnical factors such as people, workflow, and organizational issues.”
The authors discussed a Quality & Safety in Health Care paper they coauthored that provided a model with eight interrelated dimensions “designed to address the socio-technical challenges involved in design, development, implementation, use, and evaluation of HIT within complex adaptive healthcare systems.” These dimensions include:
- Hardware and software
- Clinical data stored on the system
- The developers, clinicians, patients and other humans who create and use the technology
- The workflow in which the technology is used
- The policies and procedures of the organization using the technology
“The proposed Safety Center is a step forward, but it will require strong and sustained support from a multitude of stakeholders, including vendors, researchers, and policymakers. A great deal is at stake here,” Sittig and Singh concluded. “In the absence of any other central oversight, the Safety Center will need to lead the way in making health IT safer and better, so we can improve the health and health care of our patients.”