Although medical care helps us get and/or stay healthy, there are safety risks for patients that we should all know about. And many of these risks are related to technology. As we all know, technology is great when it works, but it can be a nightmare when things go wrong. As frustrating as this is with our personal technology devices, it pales in comparison to the dangers of misused or malfunctioning health technology devices.
This post is the last post in the series covering the ECRI recent report for 2020: Top 10 Health Technology Hazards. ECRI aims to help health care facilities improve safety issues relating to medical devices and systems. But it’s helpful that consumers of health care understand these risks as well.
Here are the final safety risks for patients from ECRI’s report:
7. Cybersecurity risks for at-home monitoring devices.
An increasing number of patients use at-home monitoring equipment that electronically sends information to their doctors. These remote patient monitoring devices enable a continuous stream of real-time health data and extend the reach of doctors. Common data collected and sent includes vital signs, weight, blood pressure and heart rate. And diabetics use devices to monitor glucose levels. These devices help doctors and other clinicians identify deteriorating health issues at early stages, reducing the risk of hospitalizations.
What’s the risk?
Any time information flows between devices, there is a risk of cybersecurity. Like any other kind of networked medical device, protecting these at-home monitors from cyber threats is essential. Potential dangers include an interruption of data flow, as well as a change or degradation of the device’s performance. Since accurate, timely data on a patient’s condition is important for diagnosis and treatment, these threats can impact patient health. Additionally, there is a risk that personal, protected health information can be stolen and possibly shared.
What’s the challenge?
Although instances of cybersecurity issues regularly appear in the news, the cybersecurity of remote patient monitoring carries its own set of challenges. According to the ECRI report, the challenges include:
- These devices usually rely on the patient’s home network, which the clinician doesn’t control.
- Troubleshooting and installing updates is difficult since the equipment is in a patient’s home, limiting physical access to the device.
- Patient compliance with the proper use of a device may be difficult, especially if the patient cannot proficiently use the device or if he/she has unwarranted fears about cybersecurity risks.
How can providers reduce the risk?
First of all, health care providers must develop cybersecurity policies and practices to address this issue. ECRI recommends providers assess system security of devices when deciding which devices to use. Additionally, providers should address cybersecurity concerns when devices are given to patients – both at the patient’s home and on the provider’s network.
What can you do?
If you use a remote patient monitoring device, I suggest you consider the following:
- Ask your doctor about cybersecurity threats and how this might impact the use of the device.
- Ask you doctor how you can know if a device isn’t properly sending data.
- Follow instructions carefully, including those related to cybersecurity, related to the device.
- If you have any concerns or questions while using a device, speak up!
- Learn what symptoms would require a call or visit to the doctor. Under what circumstances should you go to the emergency department?
For information on other dangers related to medical devices, read my post: How Safe are Medical Devices?
8. Harm from MRI scans due to missing information about patient implants.
Many patients have implanted devices, such as pacemakers, artificial hips, insulin pumps and dental implants. The strong magnets of an MRI can cause an implanted device to heat up, move or malfunction, potentially leading to patient harm. To protect patients, MRI staff must know about implanted devices and follow steps for safe MRI screening prescribed by the manufacturer of the implant. But MRI staff don’t always know about a patient’s implant(s) and that can be dangerous.
Why is this information hard for MRI staff to get?
Because electronic health records (EHRs) are not standardized, providers can enter specific information about a patient’s implant in a variety of places within a patient’s EHR. The lack of a consistent record keeping protocol makes it difficult for MRI staff to determine the type and location of any implants. And sometimes this information isn’t recorded anywhere!
Furthermore, asking patients for this information can be unreliable. Some patients don’t know the specific details about their own implants. And sometimes patients are too ill to respond.
What kinds of patient harm?
If an implant overheats, it can damage the surrounding soft tissue. Additionally, the MRI system can damage the implanted device, which can then malfunction and cause patient harm. Lastly, postponing an MRI in order to research implant guidelines can delay diagnosis and treatment, which can also lead to patient harm.
What can health care facilities do?
Health care facilities should work with their EHR provider to create a dedicated place within the EHR to list each patient’s implant information.
What can you do?
Fortunately, there is an easy solution for patients. Create a detailed record with the type, brand and model, as well as the location of any implant, including dental implants. Bring this with you to any MRI appointment and share it with staff. And to be safe, keep the information on a piece of paper in your wallet – you never know when an unexpected incident, like a car accident, will land you in an MRI machine.
Before agreeing to an MRI or other test, read these blog posts:
- Are Patients Over Tested and Over Treated?
- 10 Steps to Reduce Your Risk of Diagnostic Error
- What are Doctors Doing to Reduce Diagnostic Errors?
- Help for Hard to Diagnose Health Issues
- Learn a Lesson From Serena Williams: Trust Your Instincts When it Comes to Your Health
9. Discrepancies in EHRs cause patients to get medications at the wrong time.
Patients in hospitals take a lot of medication. And sometimes, the timing of a medication is critical. However, when the EHR generates a list for nurses of medications to be dispensed, the dosage time might not coincide with the doctor’s intentions. And this can result in a missed or delayed dosage.
An example scenario.
For example, let’s say a doctor sees a patient mid-morning (after the usual morning medications are dispensed) and enters a new 1x/day medication into the EHR. Since the EHR defaults to an early morning dosage time for medications taken 1x/day, this new medication might not appear on a nurse’s list until the next day. Hence, the patient misses the first dose – which can have significant impact on a patient’s health.
What can hospitals do to improve this situation?
If an EHR order-entry system prominently displays the scheduled medication dosage time, the risk of timing errors can decrease. Additionally, these systems should make it easy for doctors to modify the dosage time, including a “now” option for medications that the patient needs as soon as possible.
What can you do?
Unfortunately, medication errors, including the timing of medications, are common in hospitals. A 2016 report estimates that preventable medication errors impact more than 7 million patients across all care settings, including patients at home. The good news is that you can take steps to reduce your risk of medication errors in the hospital. It’s important for you to pay attention to medication when you or a loved one are hospitalized!
For a detailed list of steps to reduce your risk of medication error, read these blog posts:
- How Can Hospitals Reduce Medication Errors?
- How to Avoid Medication Errors in the Hospital and at Home
- Reduce the Risk of Medication Errors in Long-Term Care Facilities
10. Loose nuts and bolts can lead to dangerous device failures.
As with any mechanical device, the nuts, bolts, and screws of the components of medical devices can loosen over time.
How serious is this issue?
According to the ECRI report, failure to repair or replace loose or missing mechanical fasteners can harm patients, bystanders and/or staff as devices can tip, fall, collapse, or shift during use. Certainly, any of these failures can lead to severe injury or death.
Additionally, these mechanical failures can compromise patient care, impede workflow and cause significant device damage.
How common is this problem?
In the past 2 years, ECRI has published nearly two dozen reports involving a wide variety of medical devices with loose fasteners. For example, they found loose fasteners on baby scale carts, which put newborns at risk. And they found loose fasteners on huge angiography systems, which could cause serious harm to anybody unlucky enough to be standing under a falling component.
What can health care facilities do?
Since the failure of even simple components can have devastating consequences, device inspections are critical. The ECRI report recommends that clinical engineers check the condition of all mechanical fasteners, even if this check is not explicitly recommended by the device manufacturer.
Additionally, clinical staff should alert appropriate personnel “to any loose or missing fasteners, irregular device movement, or unusual noises coming from a device”.
What can you do?
Sadly, not much. However, if you notice a device that seems unsteady, relay your concerns to a staff member.