July 15, 2024

Unboxed: Seeing Promise and Peril in Digital Records

Safety is also a potent argument for standards. History abounds with telling examples, like the Baltimore fire of 1904. That inferno blazed for 30 hours, destroying more than 1,500 buildings across 70 city blocks. Fire engines from other cities came to help, but could not. Their hose couplings — each a different size — did not fit the Baltimore fire hydrants. Until then, cities saw little reason to adopt a standard size coupling, and local equipment manufacturers did not want competition. So competing interests undermined the usefulness of, and investment in, the technology of the day.

Today, the matter of standards for electronic health records is raising similar concerns, prompting heated debate in recent meetings of representatives from medicine, industry, academia and government. The stakes, they say, could scarcely be higher. They agree that, when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs. But computer forms, they add, can also be difficult to use, cluttered and distracting, causing more harm than good in health care.

“This is an issue that potentially affects the health and safety of every American,” says Ben Shneiderman, a computer scientist at the University of Maryland.

The controversy points to the delicate balancing of interests involved when creating technical standards that inherently limit some design choices yet try to keep the door open to innovation. It also raises the question of the appropriate role for government in devising such technology requirements.

At issue is the Obama administration’s plan to develop standards to measure how effective and easy digital patient records are to use — applying a research discipline known as human-computer interaction or human factors. (The International Organization for Standardization, which is based in Geneva, defines the usability of a product by three attributes: “effectiveness, efficiency and satisfaction.”)

The need to improve the usability of computerized records is clearly evident — and has been for some time. A 2009 study by the National Research Council, an arm of the National Academy of Sciences, found that electronic health record systems were often poorly designed, and so could “increase the chance of error, add to rather than reduce work flow, and compound the frustrations doing the required tasks.”

At a government-sponsored gathering last month, Dr. David Brick, a pediatric cardiologist in New York, demonstrated how it took eight mouse clicks on a digital record to find the patient information presented comfortably on the single sheet of a paper chart. Hearing such complaints, countless times, from doctors and nurses is what prompted the administration to put usability on its policy agenda.

The main users of electronic health records are doctors and nurses. And the uses are tasks like recording a patient’s basic information, ordering lab tests, electronically prescribing medications and checking for possibly dangerous drug interactions. For example, taking the blood thinner warfarin (Coumadin) with aspirin, which also inhibits clotting, increases the risk of internal bleeding. The most important early measurement, officials say, will be to ensure that the electronic records are designed to avoid errors, embracing the physician’s dictum, “First, do no harm.”

The administration’s initiative takes on particular significance because this year is when the government begins spending billions of dollars to accelerate the adoption of computerized patient records.

The incentive payments, typically as much as $44,000 a physician, begin this year. But those payments require doctors to make “meaningful use” of “certified” electronic health records. The payments are staggered over five years, and to get the money physicians must use the technology for increasingly extensive record-keeping and reporting. The administration has not said whether a usability standard will be in the next stage of requirements, due by early next year.

The government says it is committed to working with technology companies, medical professionals and academics, to adopt the best approach. Yet common ground has been elusive so far.

Article source: http://www.nytimes.com/2011/07/17/technology/assessing-the-effect-of-standards-in-digital-health-records-on-innovation.html?partner=rss&emc=rss

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