Crash test dummies and The Usability of Electronic Health Records

EHR vendors were quick to say that the 2015 Edition ONC Certification for Safety-enhanced Design are too burdensome, that they are too difficult to complete, and they are not necessary. (see for example http://www.healthcareitnews.com/news/ehr-vendors-uneasy-about-meaningful... ) Many EHR vendors would say let market forces take over and the Health IT industry will heal itself.

The big business interests of the Healthcare industry may cry wolf (and lobby hard) against the meaningful use (or MACRA/MIPS) program and its significant enhancements to the usability requirements because they don’t want to spend the extra time and money to provide a healthcare system that truly follows a safety-enhanced design philosophy.

They are no better than the automobile industry that fought hard against seat belts in the late 1960 and against The United States Intermodal Surface Transportation Efficiency Act of 1991 that required airbags in cars.

In the 21st century app-based Internet twitter-verse where millions of dollars can be made in week, it may seem that ONC and the federal government is getting in the way of progress in health IT.

Federal regulations are stifling innovation, they say. Of course nobody wants to follow a long, costly and bureaucratic process in order to bring products to market. However, we need to remember that in Health IT, much like in the Auto Industry, it truly is a matter of life and death.

The Joint Commission issued their Sentinel Event number 54 outlining the dangers of usability (and other problems) with Electronic Health Record systems. Sadly, they said that:

Incorrect or miscommunicated information entered into health IT systems may result in adverse events. In some cases, interfaces built into the technology contribute to the events.

According to the Joint Commission report (http://www.jointcommission.org/assets/1/18/SEA_54.pdf) , The top contributors to these problems were the:

Human-computer interface (33 percent) -- Ergonomics and usability issues resulting in data-related errors

and

Workflow and communication (24 percent) -- Issues relating to health IT support of communication and teamwork

According to the National Highway Transportation Safety Administration, seat belts have saved nearly 63,000 lives during the 5-year-period from 2008 to 2012 (See http://www-nrd.nhtsa.dot.gov/Pubs/811851.pdf ). In addition to the 2,174 lives saved by seat belts alone in 2012, thousands (2,213) of lives were saved in 2012 by frontal airbags.

The Auto Industry fought hard against the regulations requiring that they put these safety features into cars, because they claimed, it would make cars too expensive, reduce innovation, and cut into their bottom lines.

So, the next time you get into your car, put on your seatbelt and drive off, think about your last doctor appointment and all of the various Health IT systems that they used. Do you want "market forces" to self-regulate safety standards for these devices and systems, or do you want reasonable federal standards proposed by industry experts.

With Congress working on legislation to fix major healthcare problems caused by the HITECH act, we hope that they will finally address the issue of lack of EHR usability. #SafeHealthIT saves lives.