Are EHRs Safe?

January 9, 2012

Electronic health records are fundamentally dangerous. They're also safer than the current model.

Are electronic health records (EHR) safe?No.EHRs are not safe. They are fundamentally and irreparably dangerous even during normal use.EHRs will kill people.Lots of people.EHRs have been killing people for years. They will kill even more people as they become more popular and available.Take a deep breath and get comfortable with the notion that healthcare computer systems can and will kill people. If it’s any consolation, none of the people that EHRs will kill would have gotten out alive. As it turns out, everyone gets to have a “cause of death” in the end.As one of the new “health IT” writers at O’Reilly, I feel that I should be totally up front about this: I am promoting, installing, supporting and programming software that will kill people.

Frequently.Happily, the software that I promote, install, support, and program will also save lives. On balance, it will save thousands of people for each life it takes.The healthcare system is already a dangerous place. The classic evidence for this was presented in the report “To Err is Human” in 1999 by the Institute of Medicine (IOM). It showed results that the healthcare system was killing about as many people as the highway system each year. EHR systems could do a huge amount of good for the healthcare system as a whole while still being responsible for tens of thousands of deaths each year.In fact, let’s replace “EHRs” with “cars.”Are cars safe?No.Cars are not safe. They are fundamentally and irreparably dangerous even during normal use.Cars will kill people.

Lots of people.Cars have been killing people for years. They will kill even more people as they become more popular and available.All of a sudden, the same kind of dramatic talk sounds pretty tame. We also know that cars, on balance, save more lives than they kill (just the ambulances alone …).EHRs are a fundamental technology, one that will become a pervasive part of our own healthcare, and therefore, our lives. Saying that they will “kill people” is both true and irrelevant. It’s like saying “hospitals kill people” or “dogs kill people” or “doctors kill people.” So what? On balance, we need hospitals, dogs, doctors, cars, and you guessed it … EHRs.Of course, we need to do everything we can to make EHRs safer. EHR safety will improve with time, just like cars.

Safety in the auto industry is a pretty good analogy for the health IT industry. You can look forward to further posts that extend, explain and abuse the analogy.But I hope that this post will give you a little insight into the recent results from the IOM about the safety of health it systems, (there’s an excellent overview here) and why industry defenders like H. Stephen Lieber, the president of the Healthcare Information and Management Systems Society (HIMSS), reacted with sputtering defenses of health IT. (Another excellent summary is here.)Lieber’s defense is laudable, but I think it’s a little strained.

I really wish the health IT industry would stop trying to put lipstick on this pig. The new IOM report aimed at health IT is just as pointed as “To Err is Human.” Let’s not imagine that we can dodge this bullet.We will be killing people accidentally with healthcare software over the next few years. That really sucks, but it’s worth it. So, let’s all take a deep breath, and focus on the problem. Hysterics don’t help. What helps is openness, honesty, transparency and a willingness to admit it when bad mistakes happen. Pointing fingers and getting hysterical will really not help here. Those same activities have already slowed down the privacy discussion.

Are EHRs safe? Not in the least. But they’re safer than doing nothing. They are safer than paper. You can tweet me on that.

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