Health IT and Patient Safety:
ONC Context
David R. Hunt, MD, FACS
Chief Medical Officer and Acting Director, OHITA
Office of the National Coordinator for HIT
Sir Cyril Chantler
Medicine used to be simple,
ineffective and relatively
safe.
Now it is complex, effective
and potentially dangerous.
The role and education of doctors in the delivery of healthcare.
Hollister Lecture delivered at the Institute of Health Services Research, Northwestern
University, Illinois, USA. October 1998. Lancet 1999;353:1178–81.
Hippocrates :
―As to diseases make a habit of
two things - to help, or at least,
to do no harm.‖
Epidemics I
Quality = Help
Safety = Do no harm
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Quality Healthcare
Safe Efficient
Effective Timely
Patient-Centered Equitable
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Solo 6%
EHR Adoption by Practice Size Dual 9%
>10 physicians
25 35%
3-5 physicians
Percentage of physicians
20 22%
4%
15 With notes, Rx
orders, & 6-10 physicians
ability to order 28%
10 and obtain lab
results
5
0
Physicians*
DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A
National Survey of Physicians N Engl J Med July 2008;359:50-60.
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Major Barriers to Adoption of Electronic Health Records
Capacity to select contract, install, implement
Transition productivity loss
Concerns about system obsolescence
Finding an EHR to meet needs
Uncertainty of return on investment (ROI)
Amount of capital needed
DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care —
A National Survey of Physicians N Engl J Med July 2008;359:50-60.
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―…reckoning that all
such matters should be
kept secret…‖
Hippocratic Oath
Privacy Principles, Policies, Procedures, Protections
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25550 Federal Register/ Vol. 74, No. 101/ Thursday, May 28, 2009/ Notices
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SEC. 3012. HEALTH INFORMATION
TECHNOLOGY IMPLEMENTATION ASSISTANCE.
(a) Health Information Technology Extension Program-
To assist health care providers to adopt, implement, and effectively
use certified EHR technology that allows for the electronic
exchange and use of health information…
(c) Health Information Technology Regional Extension Centers-
(1) IN GENERAL- The Secretary shall provide assistance for the creation
and support of regional centers (in this subsection referred to as `regional
centers') to provide technical assistance and disseminate best practices
and other information learned from the
39% Capacity to implement
41% Transition productivity loss
44% Concerns of obsolescence
54% Finding an EHR to meet needs
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Errant mouse click leads
NEW! MEA CULPA To negative laparotomy
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NEW! MEA CULPA
THE PATIENT: An 80-year-old woman with classic symptoms
of neuroglycopenia underwent a battery of tests confirming the
Whipple triad….
FIGURE: Normal imaging
THE MISTAKE: Three days later, a third check of antibody Despite a normal CT scan, the
surgeon reluctantly offered surgical
levels revealed a value of >90% (normal, <3%) pointing to exploration.
autoimmune hypoglycemia.
DISCUSSION: Insulin levels were far too elevated for a usual insulinoma. When faced
with a patient with all signs and symptoms of hyperinsulinism, checking insulin, c -
peptide, glucose, and sulfonylurea levels is appropriate. However, extreme insulin
elevation (typical insulinomas reveal values of 15–90 Iu/mL) suggests another source.
Insulin antibody elevations are rare. The treatment is observation and supportive care. It
resolves spontaneously.
A “systems problem” may explain the surgical team’s failure to
preoperatively check insulin antibody levels. The data is only
available via electronic medical records (EMR) with a right mouse
click. A left click didn’t show anything, so we assumed the value
was normal. Mea Culpa. Our institution is now fixing the EMR
display feature.
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Hippocrates
You better know what you
should do before you enter, for
in many cases help is needed,
not thought.
Decorum 11
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DavidR.Hunt@hhs.gov
202-690-6341
http://healthit.hhs.gov