Medical Device Daily National Editor

Estimates of the total systemic economic waste in the U. S healthcare system range from 25% to 30%, even up to 40%.

One of the culprits most frequently cited for this is the system's dependence on paper. And one of the most frequently identified solutions to this problem is the increasing shift to new e-technologies, such as email, internet and the power of computers.

But is HIT a silver bullet one that substitutes the rabbit-like speed of technology for the turtle-like slowness, and inaccuracy, of human beings?

Well, maybe, but also one with the potential to do considerable harm, according to a new Sentinel Alert just issued by The Joint Commission (Washington).

The alert warns that new healthcare information technology (HIT) and the various systems falling under that category is often proposed as a broad "cure" for the dysfunctions of U.S. healthcare but that there is no guarantee of this. A Commission statement describing the Alert says that that "implementation of technology and related devices ... may actually jeopardize the quality and safety of patient care."

And it says the risks are heightened by the increasing emphasis on "convergent" technologies, that is, the linking up of HIT systems with medical devices.

The alert emphasizes that the effectiveness and safety of HIT will be based on how these technologies are used by humans and that any technology "can have a negative impact on the quality and safety of care if it is designed or implemented improperly or is misinterpreted."

Among the people-based problems it cites in the use of technology, the alert notes several: the failure to take into consideration the necessary learning curves and potential disruptions of new technologies; inadequate planning or planning that does not take into consideration how a new technology fits into effective workflow; the general distractions of the typical healthcare environment which leads to the inevitable errors in technology use; the tendency to rely on vendor direction rather than third-party oversight in the evaluation and use of a particular technology; and the expectation that the new technologies simplifies and cuts resource requirements.

Citing this latter problem, the alert cites Bona Benjamin, director of medication-use quality improvement for the American Society of Health-System Pharmacists (Bethesda, Maryland) who says that technologies often only shift how staff is used, without reducing the amount of staffing required.

The alert also cites several general characteristics inherent in technology that cause difficulties, and potentially serious errors, in human hands: the use of an application that does not solve a particular problem and then a human "work-around" that creates more problems; system failures that aren't corrected, or corrected too slowly; the need to update systems as they emerge, but not promptly done; the existence of systems with individual applications that aren't appropriately integrated into other care systems; the development of multiple systems that are too costly and not made interoperable; and the failure to do the updating of data on a consistent basis.

While new computerized and digital systems are touted by their manufacturers as avoiding the mistakes of mistake-prone humans, the alert says that a "root cause analysis" demonstrates that computerized medication orders and automated dispensing cabinets for medications are "frequently involved" in errors.

The alert also cites several other types of systems that may be susceptible to "technology-related' adverse events: computerized provider order entry systems, electronic medical records, clinical decision support systems, bar coding and radio frequency identification systems, virus threats to information security, computed tomography technology, and patient data systems susceptible to data loss or hacking.

The alert acknowledges that there is little data to demonstrate the actual number of errors caused "by the increasing combined use of health information and devices."

Generalizing about the HIT- related errors, the alert describes a variety of reasons for them:

• When clinicians and other staff are not included in the planning process;

• When providers do not consider the impact of technology on care processes, workflow, and safety;

• When technology isn't "fixed" it becomes counter productive;

• And when technology is not updated.

The alert urges greater attention to understanding when a technology may or may not be applicable, choosing the right technology understanding the impact technology can have on the quality and safety of patient care and attempting to quickly fix technology when it is counter productive.

To reduce the risk of errors related to HIT, the alert offers 13 recommendations (see sidebar p.6).

Besides offering these recommendations, the commission urges healthcare organizations to use its Information Management accreditation standards to improve patient safety with the use of technology. Since technology is so common in healthcare from admitting patients to administering medication the commission says that its accreditation standards can be tied to technology.

Mark Chassin, MD, president of The Joint Commission said "the strategies contained in this alert give organizations and caregivers guidance that can help prevent patient harm and maximize the beneficial impact of these innovations."