Noteworthy

  • July 26, 2019

Editor’s Recommendation

The Puzzle and Promise of Electronic Health Records

by Rob Waters

June 15, 2018

In Critical Step, U.S. Caribbean Fishing Policies to Recognize Environmental, Cultural Differences Among Islands

By John Briley

Blue tang fish swim among coral off the coast of Puerto Rico. Marine life around the U.S. territory as well as the three U.S. Virgin Islands—St. Thomas, St. Croix, and St. John—will now receive protections based on the biodiversity, customs, and characteristics of each island and its inhabitants, known as island-based fishery management plans.

For all that Caribbean islands have in common—tropical weather and ocean-based economies, for example—each also differs from its neighbors, often in significant ways. On April 23, the Caribbean Fishery Management Council, which sets fishing policy for U.S. waters in the region, took a big step toward recognizing those differences while protecting the ocean, marine species, and all that both provide to the islands’ people and culture.

The council unanimously approved island-based fishery management plans that will guide rules for Puerto Rico and the U.S. Virgin Islands that are tailored to the biodiversity, customs, and other characteristics of each location. The move will protect corals and spawning fish and help ensure the sustainable catch of some popular species, including deep-water snapper and grouper. 

The plans cover Puerto Rico, St. Croix, St. Thomas, and St. John, all of which had been previously managed as one unit—an approach that didn’t account for differences in culture, fishing practices, or the marine environment across the communities. Now, for example, each of the plans might call for a different catch limit for the same species, allowing higher numbers where the fish is more culturally important and/or more abundant.

Pew supports these plans because they mark a critical step toward a more comprehensive, ecosystem-based approach to fisheries management, which considers interactions among flora and fauna within an ecosystem instead of just a single species or issue. The plans will help the ocean and the people who rely on it by balancing human needs with sustainable management of the region’s diverse ecosystems. Pew advocates for ecosystem-based fishery management throughout U.S. waters.

Most importantly, the plans will expand the umbrella of protections offered by the Magnuson-Stevens Fishery Conservation and Management Act, our nation’s primary fishing law, to 18 fish species, including mahi-mahi, that until now had no catch limits or other protections.

In addition, they will require fishery managers to safeguard the role that parrotfish and surgeonfish play in maintaining healthy coral reefs. These keystone species, which are commercially trapped and spear-fished in the Caribbean, feed on algae that would otherwise smother reefs and clear the way for new coral growth by chewing off tiny bits of coral skeleton and excreting it as sand. One parrotfish can create up to 200 pounds of sand each year. Catch limits will be lowered in St. Croix and St. Thomas, while the extraction of the largest parrotfishes will be prohibited in waters off all three islands.

The council vote also advances the protection of fish spawning habitats. Some species return to the same spots to spawn for generations; safeguarding these places can boost healthy fish populations and improve the recovery chances for species in decline. 

Some current rules remain in place, such as a prohibition on harvesting all coral species under federal jurisdiction or engaging in activities that can damage corals, such as anchoring or using certain kinds of fishing gear. Corals are often harvested to feed demand in the aquarium industry.

“This is great news for Caribbean marine life and people there who depend on healthy ocean ecosystems,” says Holly Binns, who leads Pew’s fisheries work in the region. “This new system is a testament to how well our fishery management system works in addressing diverse needs, protecting marine resources, and bolstering coastal economies.”

With the April vote, the Caribbean council is shaping a better future for the region’s people and ecosystems, a forward-looking approach that should pay dividends far into the future.

In Memoriam: Robert G. Williams, 1934–2019 

During his tenure on The Pew Charitable Trusts’ board of directors from 1996 until 2016, Robert G. Williams, a banker by profession, brought a steady hand to board governance, particularly as chair of Pew’s compensation and audit committees. His service to Pew spanned periods of global financial challenges, including the dot-com bubble of the late 1990s and the Great Recession of the 2000s, and he is remembered for the professional expertise and thoughtful advice he provided during those times. Mr. Williams passed away on April 26, 2019, in Charleston, South Carolina.

"Bob was a knowledgeable and dedicated steward of Pew’s mission and resources for many years.”

-Rebecca W. Rimel, president and CEO, The Pew Charitable Trusts


Mr. Williams, who was born in Mimico, Canada, near Toronto, received a Bachelor of Science degree from Babson Institute (now Babson College) in 1956 and graduate-level management training from Harvard Business School and the Wharton School of the University of Pennsylvania. He was chairman of the Markel Corp. of Norristown, Pennsylvania, for 12 years, and had previously spent 24 years working at Girard Bank in a variety of positions, ranging from security analyst to vice chairman and director. He also served on numerous for-profit and nonprofit boards in the Philadelphia area, and was a member of the U.S. Army from 1956 to 1958.

Mr. Williams is survived by his wife of 61 years, Rosalind; three daughters; nine grandchildren; and two great-grandchildren.

“Bob was a knowledgeable and dedicated steward of Pew’s mission and resources for many years,” said Rebecca W. Rimel, president and CEO of Pew. “He provided stability and wise counsel during times of change, and he was a person of deep conviction and sound judgment. I am grateful to have had the opportunity to work alongside him in service to the Trusts and its commitment to the public good. Pew’s staff joins me in offering their condolences to Mr. Williams’ family.”

Following his retirement in 2016 from Pew’s board of directors, Mr. Williams was named director emeritus. He had also served on the board of the Glenmede Trust Co. for 25 years, including as chairman, before retiring in 2018.

—Keith Lindblom

Better Electronic Health Records Could Reduce Medication Errors

A clinician double-checks a patient’s medical information in the operating room. Electronic health records (EHRs)—digital health information that can be shared among doctors’ offices, hospitals, and other medical facilities—have improved patient care, but challenges with their usability can sometimes cause problems.

Over the past decade, the widespread adoption of electronic health records (EHRs)—digital health information that can be shared across a range of medical settings—has improved the overall quality and safety of patient care. During the recent measles outbreak, for example, New York University’s Langone Health Network installed alerts in its EHR system to notify doctors and nurses when patients were living in a known outbreak area. The alerts, based on the patient’s ZIP code, helped identify those who might have been exposed to the virus.

Despite their many pluses, however, a recent Pew study shows that challenges remain with systems’ usability and design, and these shortcomings can inadvertently contribute to medical errors. For example, EHRs can display critical data in confusing ways or make it difficult for some users to view colleagues’ notes and other information needed to deliver safe care. Unclear system menus and settings can also lead to treatment mistakes and delays.

These problems are of particular concern for pediatric patients, who often need drug dosages adjusted by their weight or age. Pew’s health information technology project, which strives to improve safety for all patients, worked with three hospital systems to analyze 9,000 pediatric safety events from a five-year period in order to explore how EHR usability can affect the care of children. The study, published in November, found that poor usability contributed to medication errors in more than 3,200 of the incidents reviewed. Almost 1 in 5 of these mistakes affected a child’s care.

In one case, a patient received double the appropriate dose of acetaminophen because the child’s weight was mistakenly entered in pounds when the EHR was configured to record weight in kilograms. In another, an organ-transplant patient ran out of medicine used to prevent organ rejection because of a physician’s confusion with the EHR’s prescription-refill settings. Such real-world views of how these systems can misfire will help health IT administrators and policymakers understand where problems lie, the first critical step to fixing them. 

Pew’s health information technology team has recommended steps that federal officials and health care organizations can take to reduce EHR-related safety risks for children and adults alike. “Improved testing of these tools and more public data to evaluate their performance would help hospitals and health IT developers detect and correct problems before patients are harmed,” says Ben Moscovitch, the project’s director.

—Demetra Aposporos 

People in Emerging Economies See Pros and Cons to Mobile Phones

Pew Research Center surveys conducted in 11 emerging and developing countries across four global regions find that the vast majority of adults in these countries own or have access to a mobile phone of some kind, and not simply basic devices: A median of 53 percent across these nations now have access to a phone capable of accessing the internet and running apps.

And with access to the devices has come wide use of social media. Across the surveyed countries, a median of 64 percent of adults use at least one of seven social media sites or messaging apps.

In fact, smartphones and social media have melded so thoroughly that for many they go hand in hand. A median of 91 percent of smartphone users in these countries also use social media, while a median of 81 percent of social media users say they own or share a smartphone. (The median is the middle number in a list of figures sorted in ascending or descending order. In a survey of 11 countries, the median result is the sixth figure on a list of country-level findings ranked in order.)

The center interviewed 28,122 adults last September in Mexico, Venezuela, and Colombia; South Africa and Kenya; India, Vietnam, and the Philippines; and Tunisia, Jordan, and Lebanon. The researchers sought middle-income emerging economies with a variety of regional, political, economic, social, cultural, population size, and geographic conditions as part of the center’s expanding exploration of online connectivity in emerging economies.

“The rapid advancement of the mobile-social package invites people to think about the role of these devices in their lives and to look around and see how they might be affecting their societies,” says Lee Rainie, director of the center’s internet and technology research.

“On the positive side, people in these nations say they reap personal benefits from the spread of mobile phones, including the capacity to stay in touch with far-flung family and friends and obtain news about important issues. Yet, fewer say mobile phones and social media are bringing the same level of benefit to their societies, and a key flashpoint of their concern is the impact of mobile connectivity on children.”

Some 79 percent of adults in these countries said people should be very concerned about children being exposed to harmful or immoral content when using mobile phones, and a median of 63 percent said mobile phones have had a bad influence on children in their country. They also expressed mixed opinions about the impact of increased connectivity on physical health and morality.

—Daniel LeDuc