2. INDEX
INDICE
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Consentimiento:
Mala Praxis aún sin objeción médica. Fallo Judicial.
18
EE.UU.
An Inconvenient Truth: The Unquantified
Safety Risks of Electronic Health Records
12
EE.UU.
How to use Social Media Wisely - Avoid These Known Pitfalls
16
Noticias de AHRPM
Algunos eventos de los que participamos durante el 2016
21
Colombia
Una mirada a la Responsabilidad Profesional Médica
9
EE.UU.
The use of technology in healthcare and the risk implications
6
Editorial
Dr. Fernando Gomez Goldberg
3
STAFF
DIRECCIÓN GENERAL:Fernando Gomez Goldberg
CONSEJO EDITORIAL: Diego Gomez Fabbrizzi
DISEÑO & IMAGEN: Mariano Cetinic Krnjan
MARKETING: Jorge Bazán
Ecuador
Problemática actual sobre la
Responsabilidad Profesional Médica
14

3. 12
Health information technology (HIT) was heralded as a pa-
nacea for health care – it was going to improve safety, quality,
provider and patient satisfaction, and efficiency. Unfortunate-
ly, despite glimmers of promise, Nobel laureate economist
Robert Solow’s characterization of The Productivity Paradox,
thus far applies to HIT:1
“You can see the computer age every-
where but in the productivity statistics”. Berg highlighted the
paradox of HIT implemented in the name of efficiency and
improved quality of care, yet “these tools lead to an additional
burdening of the primary users and may actually diminish the
quality of care by diluting the time available for actual patient
care.”2
Organizations continue to use financial acrobatics in
attempts to nail down HIT ROI, when the conversation should
include ROS - the return on safety for HIT, a standard to
which the HIT vendors should be held accountable.
A recent Harvard report heralded that EHR safety concerns
have been overstated, and that EHRs are not unsafe.3
The re-
searchers compared patient outcomes before and after EHR
implementation and “…found that there was no difference
in the rates of inpatient mortality, adverse safety events and
readmissions in hospitals implementing EHR systems before
and after going live.” Paradoxically, the Harvard results also
confirm that EHRs have not improved safety with regard
to these major metrics. While the report contributes to our
knowledge, several key points significantly reduce the value
and generalizability of the findings:
1. The absence of injury or harm is not equivalent to
the presence of EHR safety. EHRs, as one complex com-
ponent with the larger complex can never be considered
“safe.” Organizations combine different software products
in different combinations, making universal evaluations
not only impractical, but impossible. Creating EHR safety,
then, requires 24/7/365 monitoring.
2. Safety of EHRs should be based on data collected
from the actual users of the system. Frontline users see
EHR-related safety risks and risky events – and intervene as
needed to mitigate the risk or error, preventing EHR-related
patient injury from occurring. Such “non-events” don’t appear
in Medicare or any other outcome data. Frontline users typi-
cally report only the most egregious safety issues, as they feel
they don’t have time, and they rarely hear back regarding EHR
improvements or changes based upon their submitted issue.
3. Usability/workflow challenges of EHRs increase the
cognitive burden of frontline users, and as a result, de-
creased patient safety and increase risk. Poor usability
create significant healthcare worker stress, contributing to
an evolving pandemic of burnout, redundant work effort, and
forced workarounds. In other words, the cognitive stress re-
sulting from poorly designed and functioning EHRs not only
exacerbates the potential for frontline burnout, it increases
safety risk due to HIT-related cognitive stress and burnout.
The demand for interoperability continues despite a criti-
cal component absent from the conversation: The fact that
EHRs have not been methodically and reliably demonstra-
ted to be safe.
These issues must be proactively managed with inten-
tional, methodical IT interventions to improve patient safety,
mitigate risk, and reduce cost and frontline caregiver burden.
Frontline caregivers using the EHR - physicians, nurses,
pharmacists, etc. - are the most critical individuals to pro-
vide feedback on EHR issues. As lawsuits involving EHRs
proliferate,4
frontline caregivers will increasingly be the target
of growing HIT-related litigation, and should demand their or-
ganizations help them make EHRs safer and easier to use.
AnInconvenientTruth:
TheUnquantifiedSafetyRisks
ofElectronicHealthRecords
By Michael S. Woods, MD, MMM
1. Kling R. What is Social Informatics and Why Does it Matter? D-Lib Magazine. 1999; 5(1).
(https://web.archive.org/web/20130401162141/http://www.dlib.org/dlib/january99/kling/01kling.html)
2. Berg M, Goorman E. The Contextual nature of medical information. Int J Med Informatics. 1999;56:51-60.
3. Allaying Fears. Hospitals’ transition to electronic health records appears safe for patients. Katherine Igoe. July 28, 2016.
http://hms.harvard.edu/news/allaying-fears Last accessed 08/02/2016.
4. Electronic Record Errors Growing Issue in Lawsuits. Politico. Arthur Allen. May 4, 2015.
http://www.politico.com/story/2015/05/electronic-record-errors-growing-issue-in-lawsuits-117591 Last accessed 07/26/2016.
Dr. Woods is a board certified surgeon who has fo-
cused on patient safety for over 15 years. He helped
pioneer a practical sociotechnical approach to
identifying, categorizing, and addressing HIT safe-
ty, usability and workflow issues. He is a Principal in
Sociotechnologix, LLC, and helped conceptualize
and guide the development of SafeHIT®, the first
mobile software for EHR users to quickly report
safety and usability issues with healthcare IT.
EE.UU.

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