“As our most heavily utilized tool, the EHR must also be flexible and highly optimized so as to ensure it does not adversely impact the delivery of healthcare,” Dr. Zwerling wrote. “Unfortunately, numerous surveys have found widespread physician dissatisfaction with EHR design.”
Dr. Zwerling, an endocrinologist at The Lowell Diabetes & Endocrine Center in Chelmsford, Mass., wrote that because the inner workings of EHR programming code are often not available for third-party evaluation, the risk that the EHR might contain bias and errors increases. Research has documented errors within EHRs can lead to adverse patient events and negatively impact outcomes, but the possibility of bias in programming code is generally not discussed.
Here are seven thoughts about improving the barriers to EHR quality, transparency and usability from Dr. Zwerling’s post.
• “Without a doubt, the proprietary nature of EHR programming code has the potential to adversely impact healthcare,” Dr. Zwerling wrote.
• EHR errors and bias are divided into a handful of categories within the post, including: Programming errors that can result in a system crash and bring the patient experience to a halt; random programming errors that result in a number of problems with usability; unintentional programming bias; programming code whose sole purpose is to enhance a vendor’s fiduciary interests; attempts to improve EHR workflow that ultimately impede a physician’s workflow; decisions not to include certain features as “build-ons” due to financial incentive; and unintentional design errors of omission.
• Currently, the industry waits for errors to be reported before they are fixed, but in the clinical world this is akin to waiting for a patient to come down with an illness that a dose of preventative treatment could have addressed ahead of time. The physician community should demand full transparency for EHR programming code and evaluate it as it is written to reduce errors.
• This type of approach could help address the problems of “gag clauses” written into EHR contracts, recently uncovered by a POLITICO report. These clauses can have negative impacts on patient outcomes.
• Objective assessments of health apps, which use proprietary source code, have found flaws in the code that result in the dispensing of incorrect medical information and a disregard for patient privacy.
• This year, the Institute of Medicine recommended the government require health IT vendors to routinely submit their products for independent evaluation.
• “I believe we can improve EHRs, without disrupting the EHR market or incurring federal or private expense, if all EHR programming code was published to the web as a PDF or as a text file and accessible to be read by anybody,” Dr. Zwerling wrote. This type of published information would not give stakeholders the ability to modify software, but to check its accuracy and measure its bias.
The EHR industry has benefited from the EHR Incentive Program and has a responsibility to ensure its products meet society’s needs, Dr. Zwerling wrote.
“After the EHR programming code is ‘published information,’ and the academic, medical and technical communities have scrutinized the code, we can expect to see fewer EHR errors and bias,” he wrote. “This will help ensure that EHRs evolve into the accurate, flexible and highly optimize tools which we need to deliver low cost and high quality healthcare.”
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