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Health IT and Patient Safety: ONC Context (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 14, 2009, David Hunt made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (730 KB).

Slide 1

Health IT and Patient Safety: ONC Context

David R. Hunt, MD, FACS
Chief Medical Officer and Acting Director, OHITA
Office of the National Coordinator for HIT

Slide 2

Sir Cyril Chantler

Medicine used to be simple, ineffective and relatively safe.

Now it is complex, effective and potentially dangerous.

The role and education of doctors in the delivery of healthcare.
Hollister Lecture delivered at the Institute of Health Services Research, Northwestern University, Illinois, USA. October 1998. Lancet 1999;353:1178-81.

Slide 3


"As to diseases make a habit of two things - to help, or at least, to do no harm."
Epidemics I

Slide 4

Quality = Help

Safety = Do no harm

Slide 5

Quality Healthcare

Safe Efficient
Effective Timely
Patient-Centered Equitable

Slide 6

An image of the first part of a U.S. law is shown. The title is "One Hundred Eleventh Congress of the United States of America".

Slide 7

Slide 7. EHR Adoption by Practice Size

EHR Adoption by Practice Size

  • Solo 6%
  • Dual: 9%
  • 3-5 physicians: 22%
  • >10 physicians: 35%
  • 6-10 physicians: 28%

DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care - A National Survey of Physicians N Engl J Med July 2008;359:50-60.

Slide 8

Major Barriers to Adoption of Electronic Health Records

  • Capacity to select/implement 39%
  • Transition productivity loss 41%
  • Concerns about system obsolescence: 44%
  • Finding an EHR to meet needs 54%
  • Uncertainty of return on investment: 50%
  • Amount of capital needed 66%

DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care - A National Survey of Physicians N Engl J Med July 2008;359:50-60.

Slide 9

"Reckoning that all such matters should be kept secret."

Hippocratic Oath

Slide 10

Principles, Policies, Procedures, Protections

An image of Part 1 of H.R. 1-146 is shown. The title of the H.R. is "Part 1 - Improved Privacy Provisions and Security Provisions."

Slide 11

25550 Federal Register/ Vol. 74, No. 101/ Thursday, May 28, 2009/ Notices

  • Assist clinical and hospitals to become meaningful users of electronic health records. (circled in red)

Image of the first part of the above Federal Register section is shown.

Slide 12

Sec. 3012. Health Information Technology Implementation Assistance.

  • (a) Health Information Technology Extension Program-
    • To assist health care providers to adopt, implement, and effectively use certified EHR technology that allows for the electronic exchange and use of health information.
  • (c) Health Information Technology Regional Extension Centers-
    • (1) IN GENERAL- The Secretary shall provide assistance for the creation and support of regional centers (in this subsection referred to as `regional centers') to provide technical assistance and disseminate best practices and other information learned from the

39% Capacity to implement
41% Transition productivity loss
44% Concerns of obsolescence
54% Finding an EHR to meet needs

Slide 13

New! Mea Culpa: Errant mouse click leads To negative laparotomy

An image of the cover of a magazine titled "Contemporary Surgery" is shown.

Slide 14

New! Mea Culpa

  • The Patient: An 80-year-old woman with classic symptoms of neuroglycopenia underwent a battery of tests confirming the Whipple triad.
  • The Mistake: Three days later, a third check of antibody levels revealed a value of >90% (normal, <3%) pointing to autoimmune hypoglycemia.
  • Discussion: Insulin levels were far too elevated for a usual insulinoma. When faced with a patient with all signs and symptoms of hyperinsulinism, checking insulin, c-peptide, glucose, and sulfonylurea levels is appropriate. However, extreme insulin elevation (typical insulinomas reveal values of 15-90 Iu/mL) suggests another source. Insulin antibody elevations are rare. The treatment is observation and supportive care. It resolves spontaneously.

A "systems problem" may explain the surgical team's failure to preoperatively check insulin antibody levels. The data is only available via electronic medical records (EMR) with a right mouse click. A left click didn't show anything, so we assumed the value was normal. Mea Culpa. Our institution is now fixing the EMR display feature.

Slide 15


You better know what you should do before you enter, for in many cases help is needed, not thought.

Decorum 11

Slide 16


Current as of December 2009
Internet Citation: Health IT and Patient Safety: ONC Context (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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