Application of electronic health records to the Joint Commission's 2011 National Patient Safety Goals.

SINCE PUBLICATION OF TO ERR IS HUMAN, ELECTRONIC health records (EHRs) and related health information technologies have been promoted as means to improve patient safety. This promise remains largely unfulfilled. For instance, whereas EHRs with clinical decision support (CDS) interventions integrated into computerized physician order entry (CPOE) have measurably improved clinicians’ performance on process metrics, their effect on patient outcomes remains unconfirmed. Recently, the US Department of Health and Human Services (DHHS) launched “Partnership for Patients: Better Care, Lower Costs” by committing $1 billion to improve safety. Meanwhile, EHR vendors and health care organizations have focused considerable effort on meeting standards for “meaningful use” of EHRs as required by the DHHS for incentive payments. Each year, the Joint Commission issues a concise National Patient Safety Goal (NPSG) advisory identifying the highest-priority topics for quality care. Ideally, addressing the NPSGs should be incorporated into the EHR certification process, requiring each vendor to specifically engineer targeted solutions and each organization to carefully implement and use these systems to improve safety. For 2011, the NPSG priorities for hospital quality improvement initiatives are patient identification, staff communication, medication labeling, infection control practices, medication reconciliation and interactions, and mitigation of suicide risks. Electronic health records, along with CPOE, CDS, and bar code medication administration (BCMA), if designed, developed, implemented, and used correctly, potentially play critical roles in addressing these safety goals. In this Commentary, we provide an overview of these goals, current EHR solutions and shortcomings, and potential for improvement.