Panel: culture, legal risk and incentives — not lack of technology — block nationwide real‑time safety monitoring

Experts and CMS officials told PTEC that scaling real‑time safety surveillance is primarily a cultural and organizational challenge rather than a technical one.

When a committee member asked how the automated approaches could be scaled nationally, David Classen said the systems have been implemented across more than 100 hospitals and "it's technically scalable," but organizations often keep legacy voluntary reporting systems, fear malpractice or reputational consequences, and cannot absorb a sudden increase in detected events. "A lot of reasons that organizations institutionalize their current patient safety measurement approaches... have nothing to do with technical limitations," he said.

Michelle Schryer, deputy director for quality measurement and value‑based incentives at CMS, said CMS is shifting measures to digital formats to support standardization and AI training but cautioned against immediate mandates. "There is nothing that stops the organization from learning how to use these real time in their units... but we need to study it first," she said, supporting piloting and evaluation prior to national requirements.

Panelists and committee members debated incentives: some argued past payment programs produced mixed results and could be gamed, while others pointed to large, targeted incentives (such as meaningful use or MA stars) that changed behavior. Several speakers suggested models that leave funding "on the table" for systems to claim only if they invest in demonstrable patient‑safety improvements.

Panelists recommended staged pilots—PSO‑mediated testing, unit‑level rollouts, and coordinated evaluation—coupled with governance for AI tools and legal protections that reduce disincentives to detect and disclose harm.