The push is on for health care providers to make the switch to electronic health records (EHRs) but it is hard to tell how well these complex health information technology systems are being implemented and used, writes a health informatics researcher at The University of Texas Health Science Center at Houston in a Feb. 3 commentary in JAMA, The Journal of the American Medical Association.

To improve monitoring, Dean Sittig, PhD, lead author and associate professor at The University of Texas School of Health Information Sciences at Houston (SHIS), has called for coordinated oversight by both the health care providers implementing these systems and by government authorities.

Borrowing from the safety practices of other industries, Sittig and his co-author, David Classen, MD, associate professor of medicine at the University of Utah School of Medicine, have created a five-stage proposal to monitor and evaluate these systems.

1. Report electronic health record safety issues: Currently, it is unclear who a health care practitioner would call to report a problem with an EHR system. According to Dr. Sittig, some EHR vendors discourage the release of such information. A reporting system could be created under the new Patient Safety Organizational Statute utilizing Agency for Healthcare Research and Quality reporting formats.

2. Enhance EHR certification: Vendors developing the software should be required to "demonstrate that their applications have been designed for safety, developed correctly, work as designed and had all their defects fixed," Dr. Sittig said.

3. Encourage self assessment of EHR use: Each organization should perform and document an extensive review of its clinical information systems on a yearly basis. This review should include hardware and software, clinical content, user interfaces, user training and authorization procedures, clinical workflow and communication, organizational policies and procedures, compliance with state and federal rules and regulations, and periodic measurements of system activity.

4. Conduct unannounced on-site inspections: Drs. Sittig and Classen propose random, on-site inspections by The Joint Commission, a not-for-profit organization that accredits and certifies healthcare organizations and programs, or local health departments.

5. Implement national electronic health record adverse event investigation board: Much like the National Transportation Safety Board investigates accidents, the Office of the National Coordinator for Health Information Technology could create a board to investigate EHR problems, Dr. Sittig said.

Under the direction of Jiajie Zhang, PhD, Doris L. Ross Professor and associate dean for research at the UT School of Health Information Sciences at Houston, Dr. Sittig and his colleagues recently submitted a cutting-edge, $18 million proposal to the Office of the National Coordinator for Health Information Technology to begin addressing EHR system design and implementation issues. The proposal involves eight institutions and more than 50 investigators.