As electronic health record systems become more interconnected, errors may propagate much farther than under old paper-based systems, a recent study suggested.
According to a review by the Pennsylvania Patient Safety Authority, mistakes and near misses involving electronic health records were analogous to those made with paper-based records with one caveat: those made with EHRs tend to be amplified and can affect a larger group of people.
The Authority’s study looked at 3,099 reports from Pennsylvania hospitals detailing 3,946 problems. More than 2,700 incidents involved near misses and 15 involved temporary harm to patients.
The study focused on incidents from 2004 to 2012 in which electronic health records were the root cause in the event, as opposed to being incidental.
Electronic health records are designed to be more efficient than paper-based records, but the two systems have one thing in common: they’re developed and maintained by people. The most common source of problems identified in the study rested with data entry and, to a much lesser extent, with technical glitches.
Medication errors accounted for about 80% of the cases, or 2,516 reports. Many of the remainder involved lab tests.
About half of the drug errors involved the wrong medication, with underdosing the problem in about 30%.
One problem is EHRs are connected to other systems like a hospital pharmacy, and they will only get more connected as EHR information is transmitted using health information exchanges. That means that any incorrect information entered in the record is widely distributed.
Another complication is that the deadlines established by the federal government in the 2009 economic stimulus package led to some providers rushing to set up an EHR system without adequate staff training in place.
The study noted that one big problem is several institutions are trying to use paper-based and electronic records in tandem, which creates incomplete information in one source or the other. This issue has led to overmedication in some cases and underdosing in others.
Wrong medication was the No. 1 source of mix-ups, just as with paper-based records. Talking to reporters in a webinar about the study, William Marella, program director for the Patient Safety Authority, said, “There’s no question in my mind that EHR is the smart way to go, but in the short term we are seeing safety issues.”
He added that the scale of the problem has changed, so you can have a single problem that can cascade.
Marella recalled one incident discovered in the review in which a technical glitch caused medication orders to randomly appear on some electronic medical records. The problem was not noticed until a request for an erectile dysfunction drug appeared on a female patient’s record. In a separate incident, a note that a patient was allergic to penicillin was made in the free notes section of an EHR rather than in the section addressing allergies. The patient was subsequently given ampicillin, which sparked an allergic reaction.
One way to address the current issues with electronic health records is to make systems smarter, particularly with natural language processing. Such a system could catch information even if it’s not entered in the right place.
Source: http://www.medpagetoday.com/PracticeManagement/InformationTechnology/36474?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-12-17&eun=g514381d0r&userid=514381&[email protected]&mu_id=