How to eliminate EHR-based medical errors

Electronic health record (EHR) systems are part of most physicians’ lives, but unfortunately, so is the risk of medical errors caused by software glitches or poor programming.

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A discussion at the HIMSS 2017 conference in Orlando, Florida, led by Josh Rising of the Pew Charitable Trusts highlighted some of the errors witnessed by audience members-along with potential solutions to make EHRs better and safer for all.

Some of the EHR-based problems discussed included:

·      The system switched the dosages between two drugs-one for birth control, one for asthma-for a patient. In another case, an infant’s weight changed dramatically, but the system did not adjust dosage like it was supposed to.

·      Important lab results returned with no warning that immediate action was needed.

·      Discharge instructions printed with a decimal-place error for a dosage of insulin.

·      Duplicate records for patients, resulting in an incomplete view of the medical history.

·      Print outs that contain IT gobbledygook that neither patients or doctors understand, which can be problematic in malpractice cases when a doctor can’t explain the data the system spits out.

·      Scanned documents assigned to the father instead of the son.

·      Action items that were put into the EHR that never went anywhere, resulting in missed treatments.

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With so many problems, Rising facilitated a discussion among physicians, hospital leaders, EHR vendors and patient advocates on what could be done to eliminate the issues. The Office of the National Coordinator for Health IT (ONC) is examining the idea of a collaborative that would recommend best practices by bringing all the stakeholders to the table to understand why things go wrong and what can be done to fix them to avoid medical errors.

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The question posed to the audience was: How could a collaborative be useful for you? What are activities that would be helpful to prevent safety issues stemming from EHRs?

Standardization

The audience feedback made it clear that a standardization of the general layout of EHR systems would help doctors spend less time searching for the right button or menu. It would also help prevent errors when doctors use a different system-such as when doing work as a locum tenens-where a particular button placement might do two completely different things depending on the software.

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It was pointed out by some in the audience that standards exist, but many of them were established by talking to healthcare executives and department heads, not the people using the programs on a day-to-day basis. Vendors need a better understanding of the different ways-and all the different people-that use the software. The way a physician uses the software will be different from the way someone in billing will use it, which needs to be taken into consideration if the software is to help practices be more efficient.

The best way to do this would be to not just discuss what’s needed with vendors, but for the vendors to send observers to offices and watch how the program is used throughout the average day and focus functionality on that, but with limits. Too many extra functions makes training difficult and useful functions get lost among all the bells and whistles.

Incident reporting

A collaborative from ONC would focus on safety issues, but it would require data from many systems to identify common problems with EHRs and why they are happening, says Rising. He asked the audience what type of information would be needed to make this possible.

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Audience members discussed how something like automotive regulations might work, where incidents get reported to a government agency, and if a certain threshold is reached, an investigation is launched to see if there is a particular problem within an EHR-dosing errors, for example- that needs to be addressed.

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Hospital administrators in the group wondered if the errors they experience are addressed beyond that particular case. If, for example, a dosing error occurs and the vendor fixes the problem for hospital X, does the vendor look to see if hospitals, practices and other healthcare facilities are having the same problem and fix it systemwide? 

A member of the EHR Association pointed out that there is already best practices and standards set by the association and that any further work by ONC or any other group should build on this information rather than starting from scratch.

Overall, the group agreed that medical errors associated with EHRs are a problem that it will take efforts from all groups-doctors, health systems, payers and EHR vendors-to eliminate these issues.