It's ironic: Experts in health IT concur that a major reason for healthcare systems shifted from paper to digital records was to reduce medical errors, but at the same time research has shown that EHRs actually introduce new kinds of errors.
It’s ironic: Experts in health IT concur that a major reason for healthcare systems shifted from paper to digital records was to reduce medical errors, but at the same time research has shown that EHRs actually introduce new kinds of errors.
“There’s a yin and a yang to everything,” says Jonathan Weiner, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “Health IT and EHRs have a very positive impact on quality.” Still, he says, as is true with any tool, mishaps and errors are possible and harm can result.
A research group led by Mark Graber, MD, who is with RTI international, an independent nonprofit that works on projects in both social and laboratory sciences, investigated the part played by health IT in malpractice claims.
Graber and his colleagues studied the role health IT-related mistakes played in more than 300,000 malpractice claims within an insurance database and published their findings in The Journal of Patient Safety. The group found that while health IT-related errors played a role in less than 1 percent of all the claims (248 cases), ambulatory care accounted for the majority of those cases (146 of the 248 total). Furthermore, 80 percent of the 248 health IT-related malpractice allegations concerned harms of medium-to-intense severity.
“EHRs are not really optional anymore. Data entry is a huge, time consuming thing to do, and to do it correctly takes a lot of time,” says Martin Derrow, MD, an internist in Maitland, Florida. He notes that when a physician is speeding up for efficiency’s sake and to fit in more patients, bad data entry habits can easily set in.
Experts agree that many, though by no means all, of the threats posed by EHRs are ones that individual users can address, although the responsibility for safe use of health IT is shared by diverse actors, including EHR vendors and healthcare system administrators.
Below are three suggestions that individual physicians can use to promote safe use of EHRs.
Be vigilant during times of transition: Graber’s team observed that many EHR-related mistakes occurred during periods when organizations were changing vendors or record systems, embarking on system upgrades, or extending the functionality of their systems.
Because health IT is such a dynamic field, these kinds of changeover periods will continue to be frequent. Providers need to realize that transition periods greatly raise the risk that data needed for safe patient care may be missing or incorrect, experts say. “When systems are replaced or upgraded, each section of the new or upgraded system has to be thoroughly tested to make sure that the data is correct, and that the information is received in the right location and is accessible by clinicians,” says Joyce Sensmeier, vice president for informatics at the Healthcare Information and Management Systems Society (HIMSS) North America. “It’s like when you bring in your car to have one thing fixed and they break another.”
The process of ensuring new installations or upgrades go smoothly can be highly complex. “These test plans can be hundreds of pages long,” she says.
Other issues that must be addressed include ensuring that each data field displays properly, that all data selection options are coded properly and that they display and print accurately. Still others include guaranteeing that all patient data aligns with the correct patient, and that all drop down lists appear in the correct location within the system.
Providers need to stay well informed of the transition’s or installation’s progress, of delays and of any specific functionalities being affected by the changes.
Be careful about copying and pasting entries: “If you copy and paste without looking at the data to ensure that it’s current and accurate, that can cause errors,” says Sensmeier.
Derrow finds that copying and pasting as well as an overreliance on drop-down menus can lead to the creation of records that lack useful information.
“You get this stuff back and you search in vain for any meaningful statement that somehow represents what the other physician actually thought about this particular patient,” he says.
Understand the tricky side of templates: Research done by Sue Bowman, the senior director of coding and compliance at American Health Information Management Association, showed that if physicians generate EHR content using point and click choices, many records end up with similar or identical entries. In her paper published in Perspectives in Health information Management, Bowman also found that overuse of such prefab templates sometimes led to events being documented before they had actually transpired.
At times, wrote Bowman, templates populate certain EHR fields based on particular patient characteristics or other data entries, despite the fact that this default information does not apply to a specific patient. In one example she cited, the EHR for an amputee included the “fact” that his extremities were “normal.”
In future, technology should help
U.S. medical practices have only made widespread use of electronic medical records for about ten years. Considering the amount and the complexity of the data in EHRs, it is only natural that errors occur within the digital records and result in patient harm.
Derrow, remains optimistic that the technology will improve and make accurate, patient-specific data entry easier for doctors.
“I think eventually the problem will be solved by more intuitive software programs. That is my prayer. I suspect it will be sometime after I retire,” he says.