Letters from Grassley: Health Information Technology and Medical Errors

With talk of health care reform overshadowing many of the important details of how to change the health care system, there is already $19.5 billion designated from the Stimulus package to expand the use of electronic medical records. Under the stimulus program, hospitals and physicians can claim millions of dollars for IT purchases, and will be penalized if they do not go digital by 2015.

Claims that such investments will save billions of dollars are overshadowed by many “doctors, academics, patients and computer programmers who already indicate that computer systems can increase errors, add hours to doctors’ workloads and compromise patient care.” These issues are further exacerbated by the fact that many current systems are “clunky, counterintuitive, and in some cases dangerous,” especially since many are incompatible with each other.  There is also the problem of effectively training staff, updating software, and data entry error, according to the Washington Post.

For example, “researchers at the University of Minnesota found in March that electronic records prevented only two infections a year.” Another study from a “2005 report in the journal Pediatrics found that deaths at the children’s hospital at the University of Pittsburgh Medical Center more than doubled in the five months after a computerized order-entry system went online.”

Other doctors spoke of cluttered screens, unresponsive vendors and illogical displays. More than one in five hospital medication errors reported last year — 27,969 out of 133,662 — were caused at least partly by computers, according to data submitted by 379 hospitals to Quantros Inc., a health-care information company. Paper-based errors caused 10,954 errors, the data showed.

Such a controversy surrounding the effectiveness of billions of dollars from taxpayers prompted Senator Charles Grassley (R-IA) of the Senate Finance Committee to gather “testimony alleging serious computer flaws from doctors, patients and engineers unhappy with current systems.”

As a result, the Senator wrote to 10 major suppliers of electronic record systems on October 16, 2009, demanding to know, for example, what steps they had taken to safeguard patients. Companies that received letters included: 3M, Allscripts, Cerner, Cognizant, Computer Sciences Corp., Eclipsys, Epic Systems, McKesson, Perot Systems and Philips Healthcare. (The Washington Post this weekend mentioned the Cerner letter.)

Mr. Grassley specifically told the companies that “every accountability measure ought to be used to track the stimulus money invested in health information technology.” Accordingly the Committee, in cooperation with the Food and Drug Administration (FDA) asked for disclosures including:

–   Faulty software that miscalculated intracranial pressures and mixed up kilograms and pounds.    

–   A computer system that systematically gave adult doses of medications to children.       

–   An IT program designed to warn physicians about wrong dosages that was disconnected when the vendor updated the system, leading to incorrect dosing.   

–   A software bug that misdiagnosed five people with herpes.

In order to measure whether such problems outweigh the “meaningful use” of HIT, David Blumenthal, the head of health technology at the Department of Health and Human Services (HHS), will work on the standard that hospitals and physicians will have to reach before qualifying for health IT stimulus funds.

Giving oversight to Mr. Blumenthal, Senator Grassley has stressed in his letters the “complaints he has received about systems that allow doctors to enter medical orders by computer. (Here’s a copy of the letter.) He even wants to know whether the companies typically include legal provisions in their contracts that “shift responsibility for errors in the … systems to physicians, nurses, pharmacists, and other health care providers” according to the Wall Street Journal.

Such policies Grassley cites “include ‘gag orders,’ which prohibit health care providers from disclosing system flaws and software defects.” He asks the companies how many settlement agreements they’ve executed in the last 18 months. (Several of Grassley’s allegations echo themes in this essay published earlier this year in JAMA.)

While an investigation into the effectiveness of HIT and electronic medical records is important, it is a very small piece of the puzzle. With “barely 8 percent of hospitals using a basic electronic medical system, and only 17 percent of physicians using electronic records,” it seems obvious the drawbacks outweigh the benefits.

For example, 20 percent of physician groups in Arizona are uninstalling HIT software, according to a June survey by HealthLeaders-InterStudy. In Britain, a $20 billion program to digitalize medicine across the National Health Service is five years behind schedule and heavily over budget. Other complaints include losing time with patients because of data entry, causing physician productivity and satisfaction to fall.

Ultimately, because electronic medical records are not classified as medical devices, and thus hospitals are not required to report problems, these issues may continue to grow. Accordingly, HIT should be heavily reconsidered and studied at greater length because physicians did not go through years of training to have their ability to take care of patients destroyed by devices that are an impediment to medical care.