The National Quality Forum (NQF) issued a report to identify and address patient safety issues related to health IT, listing several recommendations.

The report, "Identification and Prioritization of Health IT Patient Safety Measures," said that with proper design, implementation and use, healthcare organizations can reduce medical errors and improve care quality. But health-centric technologies can also create new hazards and opportunities for error.

Following are the nine technological areas where NQF sees potential problems and suggested remedies:

1. Clinical Decision Support: Poorly designed or configured CDS systems can disrupt care and threaten patient safety. CDS should be designed and implemented without overwhelming clinicians with "alert fatigue" or unnecessary alerts or excessive information. CDS systems should reviewed to address the appropriateness and timing of alerts, the appropriateness of clinicians' responses to those alerts, and CDS content should be monitored to ensure that it remains useful, clinically relevant, up-to-date, and free of errors, particularly for high-risk situations.

2. Information interoperability: While the use of HIT has improved information-sharing considerably, many EHRs are still not interoperable, and problems can emerge from the interfaces between EHRs and other clinical systems, such as lab information systems. First, improving interoperability depends not only on actions and interventions by organizations and IT vendors across diverse internal systems -- challenging tasks in their own right. Additionally, a wide range of external factors must be considered, including the cooperation and performance of other healthcare providers, the existence of regional databases facilitating information exchange, and the legal, policy, and regulatory environment. But interfaces can be improved where possible, and the ability to exchange information can be measured. Sources for assessing effective interoperability can include surveys of users to assess how a lack of interoperability impacted medical care, assessment of help desk reports, and information provided by vendors. In addition, data from providers or the EHR itself at the point of care may be instructive.

3. Patient identification: Potential safety issues related to patient identification include the creation of duplicate patient records within an organization's system, 'overlay' of a patient's information into the wrong person's record and, ultimately, care delivered to the wrong patient because of problems with identification. Wrong-patient errors, in fact, have been among the most common human-computer interface issues, particularly in the context of EHRs because incorrect information may spread across other systems and affect multiple encounters. Accountability for patient identification could be shared across all stakeholders, including vendors, healthcare organizations, clinicians, and even patients. Each stakeholder should take an important role in ensuring that patients are accurately identified, duplicate records are merged, and systems are designed to detect and remediate patient identification problems.

4. User-centered design: Better-designed, more user-friendly systems could potentially reduce error rates and make care safer. Usability testing/evaluation and user-centered design are important to achieving these goals. Another key means of promoting safe design and use of HIT systems is through simulation. A standardized approach to usability is necessary for meaningful and comparable measurement, and guidelines recently released by the National Institute of Standards and Technology (NIST) can help in this area.

5. System downtime: EHRs have become mission critical, thereby underscoring the importance of not only keeping them running but also of downtime prevention and mitigation. While downtime can't be totally avoided, it's important for organizations to have backup or redundant systems in place. Having multilevel, overlapping systems that work together and in isolation to protect EHR data in instances of downtime can ensure that clinicians have access to needed information. Comprehensive and effective disaster or emergency planning can help reduce the disruptive impact of downtime.

6. Feedback and data-sharing: With EHR technology rapidly evolving, it's essential to publicly share "lessons learned" and solutions about patient safety problems in the user community. Feedback and information-sharing among vendors, users, and healthcare organizations can enhance their safe use. Some vendor contracts, however, contain broad nondisclosure and confidentiality provisions as well as other intellectual property protections that prevent certain EHR software information, including screenshots and comparative user experiences, from being publicly shared. Software license and hardware purchase agreements should support and facilitate information-sharing, with both vendors and healthcare organizations bearing some responsibility in this area.

7. High-quality documentation: Timely documentation and communication of information during care transitions are vital to ensuring patient safety. Good clinical documentation can facilitate transitions in care and ensure that diagnoses, medication lists, allergies, and other critical information is captured and communicated appropriately as patients move across care settings. Timeliness is similarly important,

8. Patient engagement: Patients' increasing ability to engage in their own care through technology is emerging as an important area for HIT safety. To continue to develop this important trend, it will be critical to examine results to see why patients are or are not engaging in their care. In addition, there are disparities in both access and ability to interact with technology that will need to be considered for measurement. Multiple stakeholders should share accountability for the effective design, implementation, and use of patient portals.

9. Risk-management infrastructure: Accountability for having an HIT safety infrastructure primarily rests with healthcare organizations. However, it is important for vendors to have similar mechanisms to rapidly respond to and remediate software or hardware issues that cause safety risks and problems.

NQF's report was written by a committee made up of experts in health information technology data systems, electronic health records (EHRs), and patient safety, providers across different settings, front-line clinicians, health plan representatives, and experts in patient safety issues related to the use of HIT.

"HIT will fulfill its potential only if the risks associated with its use are identified and a coordinated effort is developed to mitigate those risks," the report said. "Accordingly, there is a need for measures to help identify the nature, scope, and prevalence of HIT-related safety issues and to assess how well providers, vendors, and others are preventing or mitigating HIT-related safety concerns."