Among the ten technology related hazards published by ECRI Institute in their November issue of the organization’s Health Devices journal, three are associated with health IT.

The list was developed based on the information provided by healthcare organizations; ECRI’s medical device concern reporting databases; and the expertise, analysis, and judgment of employees across various departments. It contained hazards that met either all or one of the following criteria: frequency of occurrence, potential for harm, insidiousness, ability to affect a huge population, and if it has had high profile, and substantial media coverage. Additionally, it was also analyzed if inclusion of any topic could bring about positive changes in the future.

The three health IT related topics in this year’s list include:

Mismatch of patient or health information in either EHR or other IT systems
With health IT systems possessing the ability to collect and pass on health data from and to various systems and devices, it can be difficult to identify and rectify any patient or data related errors, and their effects. Errors can occur when the medical device and EHR are not disconnected properly while shifting the device from one patient to another. Additionally, errors can also occur if the system cannot perform association and dissociation functions at times of network outage, while connectivity solutions continue to store the information and then retransmit it to patient records when the network is up. In order to minimize the risk of errors associated with mismatched data, while considering implementations, evaluating systems for buying or setting up workflows, ECRI recommends that providers choose an EHR-patient association method (bar code or pick list) that suits their workflow and also make workflow adjustments. Additionally, movement of devices and patient flow need to be taken into account for all expected types of transfers. Further, testing of system functionality during and after the implementation process is also recommended.

No connectivity between Health IT systems and medical devices
Although interoperability is capable of lowering manual documentation related errors; enhancing patient safety; furnishing information to enable any time, anywhere clinical assistance; allowing collection of data for retrospective review; automation of clinical documentation; and remote supervision; achieving it is not easy and can harm patient if not effective. Some of the situations which can increase the risk of hazards include, incompatibility among different systems, inaccurate functioning of interfaces between different medical devices, ineffective change management wherein, changes to one of the interfaced device affects the other system as well. According to ECRI, healthcare organizations can mitigate the risks by planning carefully and by maintaining records of all interfaced systems and devices, including the configurations and software versions. Identification, evaluation and prioritization of interface-associated risks, along with following best practice, as illustrated by International Electrotechnical Commission’s IEC 80001-1 standard, is advocated. Additionally, ECRI also suggests that healthcare organizations evaluate, consent, and implement changes to interfaced systems/devices in a controlled manner.

Distractions to caregivers from smartphones or mobile devices
It is easy for providers to get distracted and indulge in their personal business during care hours with the access to mobile devices/smart phones and internet. Providers can even miss out on signs that indicate patient’s clinical condition while concentrating on the screen of the mobile device. Distractions from communication devices can lead to poor care quality or even physically harm patients. It can leave patients wondering about the care received. In view of this, ECRI recommends healthcare facilities to educate their employees and independent doctors about the communication device-associated risks and create awareness about the effect distractions can have on care delivery. Further, ECRI also emphasizes that healthcare facilities consult all the stake holders and develop policies that define inappropriate and appropriate usage of mobile devices. Development of a strategy to manage mobile devices is also recommended. The strategy should address issues related to security (protecting the information networks’ integrity and privacy of the patient health information), and ways in which the usage of mobile devices can jeopardize safety of the patients. While development of policies that limit the use of mobile devices during patient care hours cannot completely ward away the distractions at the care setting, it can lower their number.

The complexity involved with HIT-associated medical technologies, their ability to introduce novel methods for failure, and the likelihood of such failures impacting patients even before it being noticed, coupled with incentives for complying with ‘Meaningful Use’ criteria, makes ECRI to encourage healthcare organizations to focus on Health IT while prioritizing the safety initiatives for upcoming years.

Apart from the above three, ECRI also cited the following as hazards in their annual report:

• Inaccurate functioning of medical device alarm
• Errors in medication administration while using infusion pumps
• Unnecessary radiation exposures and radiation burns associated with diagnostic imaging procedures
• Harm inflicted by air embolism
• Neglecting pediatric patient’s needs while using ‘adult’ technologies
• Inadequate reprocessing of surgical instruments and devices used in endoscopy
• Surgical fires