ECRI Institute has issued its annual list of the top 10 health technology hazards. While addressing all hazards on the list is critical to ensuring safe, high-quality care, we want to highlight a few hazards that we find particularly noteworthy.
Coming in at #9 is "Medication Errors from Dose Timing Discrepancies in EHRs." An executive brief for the "Top 10 Health Technology Hazards for 2020" report states,
"Missed or delayed medication doses can result from discrepancies between the dose administration time intended by the prescriber and the time specified within the automatically generated worklist viewed by the nurse."
Organizations must develop processes to eliminate the potential for such discrepancies. The ramifications of such errors can "have significant clinical consequences," ECRI notes, depending on the patient's condition and the medication prescribed.
Reducing medication errors must be a high priority for any organization. We previously shared medication error statistics showing the tremendous patient harm associated with and frequency of such dangers. Helping clinicians reduce medication errors is just one of the reasons why we developed Meds 360°.
At #6 is "Alarm, Alert, and Notification Overload." This comes as no surprise. Such overload — i.e., alarm fatigue or alert fatigue — has been a significant problem for years; one further magnified with the adoption and growth of electronic health record (EHR)/electronic medical record (EMR) systems. As an American Association for Physician Leadership article written by Dr. Brent Beasley notes,
"EMR systems flash so many alerts — more than 100 a day, by one estimate — that we can become numb to them … when providers see an alert — much like smokers and the Surgeon General's warning — they no longer think about it."
ECRI notes that alarms and alerts come not only from EHRs/EMRs but also the ringing of phones, buzzing of texts, beeps from nurse call systems, and more. The executive brief states,
"More than ever before, clinicians have to divide their attention between direct patient care tasks and responding to prompts from medical devices and health IT systems. As the number of devices that generate alarms, alerts, and other notifications increases, so too does the risk that the clinician will become overwhelmed, creating the potential for a clinically significant event to go unaddressed."
What can be done about alert fatigue? While there are no easy solutions, an Agency for Healthcare Research and Quality Patient Safety Primer shares the following suggestions:
- Increase alert specificity by reducing or eliminating clinically inconsequential alerts.
- Tailor alerts to patient characteristics and critical integrated clusters of physiologic indicators.
- Tier alerts according to severity.
- Make only high-level (severe) alerts interruptive.
- Apply human factors principles when designing alerts (e.g., format, content, legibility, and color of alerts).
At Cureatr, we are well aware of the additional strain that notifications and alerts put on clinicians. We have designed our solutions with alert fatigue in mind, and allow care providers to configure which alerts and notifications they receive in our medication management solution, Meds 360°.
Lack of Implant Information
At #8 is "Missing Implant Data Can Delay or Add Danger to MRI Scans." Like the medication error hazard, this is another challenge created by information discrepancies.
As the executive brief states,
"Some implants can heat, move, or malfunction when exposed to an MRI system's magnetic field. Thus, MRI staff must identify and follow any contraindications or conditions for safe scanning prescribed by the implant manufacturer."
That, of course, is not doable if staff are unaware of implants prior to performing an MRI or fail or are unable to ask patients if they have an implant(s).
One solution? ECRI advises healthcare facilities to "… work with their EHR provider to create an implant list stored within the patient record. Similar to an allergy or medication list, an implant list collects all relevant information in one easy-to-access location."
Home Health Cyber Risks
The #7 hazard is "Cybersecurity Risks in the Connected Home Healthcare Environment." Cyber threats took the top spot on ECRI's "2019 Top 10 Health Technology Hazards" list, and they remain one of the biggest challenges facing healthcare organizations today. In the most recent list, ECRI spotlights cyber risks associated with remote patient monitoring (RPM) technologies.
RPM is a type of telehealth delivery system. We previously highlighted several of the most significant telehealth benefits. We also noted that there are telehealth challenges stifling adoption, which include security. Security risks associated with RPM technologies recently caught the attention of federal regulators, specifically the National Institute on Standards and Technology (NIST). NIST is seeking assistance from the connected health industry to offer secure RPM programs, reports mHealthIntelligence.
One reason telehealth security is so problematic is that while a provider has control over its network and decisions concerning cybersecurity, including staffing and investments, it has much less control over the networks of its patients. A NIST report on RPM states,
"Traditionally, patient monitoring systems have been deployed in healthcare facilities, in controlled environments. RPM, however, is different, in that monitoring equipment is deployed in the patient's home, which traditionally does not offer the same level of cybersecurity or physical-security control to prevent misuse or compromise."
"A cybersecurity issue that interrupts the transfer of data to the healthcare provider, for example, could lead to misdiagnosis or a delay in care. Challenges include: the deployment may rely on the patient's home network, which the provider doesn't control; physical access to the device is limited, which can complicate troubleshooting and installing updates; and patient compliance can be difficult to sustain, particularly if the patient lacks proficiency using the device or has unwarranted fears about cybersecurity risks."
Recommendations provided by ECRI include assessing security during device purchasing and addressing security considerations during installation at the patient's home.
The complete "Top 10 Health Technology Hazards report" is accessible to ECRI Institute members. The executive brief is available for complimentary download at www.ecri.org/2020hazards.