This appeared over the weekend.
More tests vital for health IT
Date December 2, 2012
Category Opinion
Enrico Coiera and Farah Magrabi
A doctor calls up the drop-down menu on her electronic prescribing system, looking for the heart drug digoxin. The 225 options are listed in counter-intuitive alphabetical order and she clicks on the wrong dose. Her patient is given four times the amount he needs.
Another healthcare worker finds the computer's font hard to read and accidentally gives a patient 10 times the correct dose of epinephrine (adrenalin). The patient dies.
These are just two of the many serious events that we at the University of NSW Centre for Health Informatics have unearthed while analysing accidents and mishaps involving health information technology reported to the US Food and Drug Administration from January 2008 to July 2010.
The recent accidental deletion of 10-year-old Ezekiel Howard's electronically stored heart scans, along with two months' worth of similar scans on other patients' hearts at Nepean Hospital, is another example of an IT incident that has the very real potential to harm patients.
There's no formal requirement to report errors such as these - unlike adverse patient safety events from medication or medical negligence. But the few studies that have been done into errors associated with computerised health information systems are pointing to a disturbing fact: as much as technology can improve the health system, it can also have deadly side effects.
IT is transforming doctors' surgeries, pharmacies and hospitals. Over the next 10 years, more IT will be deployed in health systems worldwide than in their entire history.
You've probably already seen the start of it. GPs don't write prescriptions any more. They print them out using an electronic system, which then files away information on your medication history and your medical history, to build a growing database. Indeed, you may even have entered your own history into the new Personally Controlled Electronic Health Record, which the government launched in July.
There is no doubt technology will contribute much to healthcare - better record-keeping, better communication in a complex system, and better information about patients' medical histories. It will be evermore crucial to rein in costs and create efficiencies as governments worldwide cope with ageing populations, a shortage of healthcare workers and an increasing workload due to obesity and chronic disease - and do so with fewer resources.
But here's the rub. If we were introducing a new drug or surgical procedure, we'd be proving it worked in large clinical trials and running exhaustive tests to get it registered by a national regulatory authority. For health IT, there is no such regulation.
.....
Enrico Coiera is a professor and Farah Magrabi is a senior research fellow at the University of NSW Centre for Health Informatics.
The full article is found here:
http://www.smh.com.au/opinion/society-and-culture/more-tests-vital-for-health-it-20121201-2anka.html
These three paragraphs worry me a lot, especially the third one:
“IT is transforming doctors' surgeries, pharmacies and hospitals. Over the next 10 years, more IT will be deployed in health systems worldwide than in their entire history.
You've probably already seen the start of it. GPs don't write prescriptions any more. They print them out using an electronic system, which then files away information on your medication history and your medical history, to build a growing database. Indeed, you may even have entered your own history into the new Personally Controlled Electronic Health Record, which the government launched in July.
There is no doubt technology will contribute much to healthcare - better record-keeping, better communication in a complex system, and better information about patients' medical histories. It will be evermore crucial to rein in costs and create efficiencies as governments worldwide cope with ageing populations, a shortage of healthcare workers and an increasing workload due to obesity and chronic disease - and do so with fewer resources.”
My view is that while there is absolutely no doubt we need the appropriate regulation to ensure Health IT (or e-Health as DoHA and NEHTA want to call it) is both safe and effective that we also need a few other boxes ticked.
Among these are that we need the appropriate leadership and governance frameworks for the introduction of the technology and that benefits are properly assessed, tested and then proven to have been delivered through rigorous evaluation.
I would suggest that the benefits case for the NEHRS / PCEHR program is very weak, has never been subjected to independent scrutiny and is basically a fanciful fiction.
It seems to me the authors need to have gone a little further than they did to push past the mentality being pushed by the Government that if you build e-health ‘they will come’ and that it will really work safely and actually deliver the benefits claimed.
All those views are on pretty rocky ground as far as I am concerned.
On a different track and from the same source.
Surveillance shows potential in detecting HIT system failures
November 26, 2012 | By Susan D. Hall
An Australian study finds potential value in applying a syndromic surveillance system to health IT systems to detect early system failures.Such surveillance typically is used in public health to monitor the spread of infectious diseases. The system was used in research at the University of New South Wales in Sydney to monitor four factors in a tertiary hospital laboratory: total number of records being created, the number of records with missing results, average serum potassium results, and total duplicated tests on a patient.
The researchers, led by Dr. Mei-Sing Ong, wanted to detect HIT system failures causing: data loss at the record level, data loss at the field level, erroneous data, and unintended duplication of data, according to a paper published at the Journal of the American Medical Informatics Association. Statistical models were used to detect system failures using simulated outages lasting 24 hours, with error rates from 1 percent to 35 percent.
More here with links:
Keep the work coming guys (and gals).
David.
