EHRs Don’t Make Errors, People Do

An intriguing blog title, I know. I saw it on Bill Crounse, MD’s blog post and couldn’t resist extending the discussion. This is a really challenging topic and so it’s definitely worth of discussion.

On the one hand it’s clear to me that EHR software isn’t perfect. However, paper charts weren’t perfect either. On the other hand, people aren’t perfect either. Unfortunately, we don’t want to admit our imperfection and our society has gotten to the point that imperfections are unacceptable.

In the blog post mentioned above, Dr. Crounse offers the following suggestions and I’ll add my own commentary for each:

Involve the Patient Right from the Start – I’m hopeful that some of the companies working on this problem will get widespread adoption. The patient could definitely be more involved in entering their patient data before the visit even happens and thus relieve the burden on the clinician. This is a challenging problem to solve though when you consider the vast array of physician preferences.

Ease the Documentation Burden on Clinicians – This is mostly a knock on our current billing system. If we make the switch to value based reimbursement can we ease the documentation burden on clinicians? That’s worthy of its own post and some deeper thought. Sadly, I think in the short term it likely means more documentation burden for clinicians. I don’t see this happening soon, but it’s a noble goal.

Prohibit Templates, Cut and Paste – I generally disagree with this one. Ironically, the title of the post illustrates my issue with it, “Electronic Health Record solutions don’t make errors, people do.” It’s not templates and cut and paste that’s the problem as much as it is rushed physicians who don’t use it appropriately. I think one word describes most of the issues: laziness. I know. When I use a template for my blog posts or email blasts, I get lazy on them sometimes too. Fortunately, my blog posts or emails don’t have people’s lives hanging on them. So, maybe Dr. Crounse has a point. It’s just too easy to screw up templates and copy/paste.

Share Information with Patients – I’ve long been a proponent of the patient being aware of the information in the paper chart. I know that many doctors fear this. Usually they reference the fear that patients won’t understand the information that’s in the chart. I’ve just not seen this to be the case in practice and the benefits of the patient being able to be involved in their chart is so much more valuable than any perceived risk. The harder part is that I haven’t seen any system which creates a simple way for the patient to update/correct/verify information in a chart. Access is a great step forward, but the next steps is to empower the patient to assist in the patient chart quality control process.

As long as we have imperfect humans using imperfect EHR software, errors are going to happen. However, we can do better than we’re doing today. I like the ideas that Dr. Crounse suggested. I’d love to hear any ideas you have as well.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

7 Comments

  • Folks need to realize that heath care documentation is done for three reasons.
    1) Health care delivery (that’s the obvious one)
    2) Regulatory compliance (checking all the boxes our govt. and payers think are important)
    3) Malpractice avoidance (no one wants to get sued)

    If all we needed to do with our documentation was practice medicine (#1 above), our notes would be much less bloated and logical. Cut and paste would occur a lot less often, and likely could be limited to appropriate uses such as carrying over past medical history (which should ALWAYS be cut and pasted after verification to REDUCE ERRORS).

    It is the #2 and #3 health care documentation purposes that are responsible for the large majority of the crap that shows up in our notes. Believe me, we doctors would all love to confine our work to health care delivery, but external forces box us into this uncomfortable place, and this creates crappy documentation.

    I find it absurd to hear anyone say copy/paste and templates need to be abolished. Do these people see patients? It would be impossible to do the job. Do you think the legal profession would consider eliminating templates and copy/paste? Do you think those contracts and wills are written freehand each time? Ridiculous.

    Folks need to stop confusing healthcare documentation with health care delivery. Unless you are a clinician, all you see is the former. Those actually taking care of patients know where to set their priorities.

    Edward J. Schloss MD
    @EJSMD

  • Healthcare documentation is often so far off base that the public would be horrified if they knew what was in their records. The well documented problem of drug addiction inside healthcare, not listening to patients has poisoned the well of any and all of the public’s current and future care.

    Even compassionate, well meaning providers know they can not trust medical history or their own counterparts because of two reasons.

    1. The absence of providers bot being held accountable for their actions has produced a cesspool of medical records that will have horrifying effects for generations. If providers feel any sense of sorrow when patient harm happens, (1,000 deaths every day) well, lets look at the records and you’ll see the root cause is

    1. Zero accountability
    2. Sloppy work

    Copy/Paste is just part of the problem.

  • I agree with Dr. Schloss and John. Copy and Paste or more efficient way of ‘Inherit’ functionality is a key driver to complete the documentation efficiently, especially for the follow up visits where the HPI is same or similar. This documentation is way better than the hand-written documentation which may or may not be readable for as many reasons. I don’t believe there is anything inherently wrong in this functionality; in fact it enhances the efficiencies that technology presents.

    On point #2 of Dr. Schloss, some of those regulatory requirements may be in the best interest of the patient & healthcare delivery; more as a check list than anything else; and some could redundant. This comes with the territory.

    #3 about avoidance of mal-practice and legal defense – if the documentation had captured every aspect of healthcare delivery, that, in and off itself, is a good defensive tool.

    More importantly, the documentation should be considered as something that the consumer will get to read and it should be worded and authored accordingly. This is a cultural shift and might take a few months, at the least. We suggest that – prior to giving the access to patients of complete documentation – start the practice of documenting as if the patient has the access already and modify the nuances accordingly. This facilitates a willing patient engagement which can also go a long way in eliminating errors.

  • All of these points are valid. The value of proper clinical documentation cannot be understated for delivery of care, patient safety, population health management… And as Anthony states “should be considered as something that the consumer will get to read and it should be worded and authored accordingly.”
    I work in the world of medical transcription and EHR data migration. One of our tasks is to “translate” the meaning of the clinical notes. Some of the things we see are just plain crazy while some are downright dangerous. I hope to see a trend toward clarity and standardization as we move to more visibility. The days of shared documentation are here!

  • Dr. Schloss,
    I like your breakout of the various purposes of documentation. I’d probably split regulatory compliance into regulatory compliance and reimbursement. You might say that regulatory compliance is a part of reimbursement, but I think MU made those two major items with different agendas.

  • History is replete with examples of how poor user interface design, as is found in many, many EHRs, has induced users to make mistakes.

    Ron

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