A new report from the s-association-amia" target="_blank" class="directory-item-link">s-association-amia" target="_blank" class="directory-item-link">American Medical Informatics Association (AMIA) offers recommendations for reducing or eliminating "tensions" between healthcare IT vendors and their customers – specifically with regard to indemnity and error management.
The suggestions, the result of deliberations by an AMIA Board-appointed task force, seek to help foster greater use of EHRs and other tools in the transition from paper records by increasing transparency, veracity and accountability in healthcare IT vendor-customer relationships.
AMIA's initiative aims to foster more collaborative education focused on the installation, configuration and use of health IT systems, in combination with enterprise-wide ethics education to support patient safety.
"There was a need to consider, study and analyze questions of appropriate oversight," said AMIA Board Chairwoman Nancy M. Lorenzi, assistant vice chancellor for health affairs and a professor of biomedical informatics at Vanderbilt University.
"With as much interest and investment in HIT as there is today," she said, "AMIA – an unbiased third party – wanted to take a fresh look at gray areas that currently exist between vendors and their customers to see where new practices could be implemented to better support patient outcomes and protect patients, who these systems ultimately serve. We think these recommendations do an excellent job of addressing fairness and balancing accountability in the HIT marketplace and in the health sector."
The report – titled "HIT Vendors, their customers and patients: New challenges in ethics, safety, best practices and oversight" – makes specific recommendations on contract language, education and ethics, ethical standards, user groups, best practices, and marketing. An additional section addresses regulation and oversight of the HIT Industry and next steps.
The report's first author, Kenneth W. Goodman, director of the University of Miami bioethics program, chaired the task force, a group of AMIA members comprising nationwide representatives of academia, industry, and leading healthcare institutions.
"AMIA provided an important forum in which complex and sometimes conflicting positions were candidly discussed, analyzed and balanced," said Goodman. "HIT systems are ubiquitous these days and need better oversight. These recommendations demonstrate a high-value commitment to patient safety, quality care, and innovation – healthcare goals sometimes difficult to reconcile."
The recommendations, he added, "can help individual institutions do more to support successful HIT implementation."
Among those suggestions is contract language specified to protect patient safety and spell out the shared responsibility that vendors and their customers have for successful implementation. "Hold harmless" clauses in contracts between vendors and purchasers or clinical users, that absolve vendors for errors or defects in their software, are declared unethical by AMIA.
The AMIA position states that "safe and successful" healthcare IT systems "further require ethics education, which has become a standard part of professional development in the corporate world."
Vendors and their clients are urged to adopt enterprise-wide ethics education to parallel what accrediting healthcare organizations require. Standards for corporate conduct and subsequent education about such standards are also recommended. A variety of informational tools, many aimed for post-market use, are cited among best practices to assist institutions and clinical practices in achieving optimal HIT implementation.
AMIA President and CEO Edward H. Shortliffe, MD, praised the task force. "This group of informatics and industry leaders recognized the need to meld business ethics into successful adoption of HIT," he said. "Their recommendations balance the forces that drive the competitive HIT marketplace with the practical needs of clinicians, patients, researchers, public health workers and officials. AMIA stands by their work and hopes these recommendations will be embraced by the HIT community."
