Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Study: Doctors Made More Note-Taking Errors With EHRs Than Paper

Posted on July 19, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study appearing in the Journal of the American Medical Informatics Association has concluded that a sample group of physicians made more data entry errors with a new EHR than in comparable paper records, according to a HealthcareITNews item.

Researchers studied progress notes created at a Michigan hospital, Beaumont Hospital of Royal Oak, Michigan, between August 2011 and July 2013. They looked at 500 notes created during that period, some of which were prepared before the EHR implementation in 2012 and some after. The charts contained five specific diagnoses which always include physical findings, including permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis.

Upon analysis, they found that rates of inaccurate documentation were 24.4% with the EHR, versus 4.4% with paper records. Residents had fewer inaccuracies (5.3% vs. 17.3%) and omissions (16.8% vs. 33.9%) than attending physicians.

While this is no reason to throw the EHR baby out with the bathwater – after all, the physicians in question were learning a system for the first time – it’s still a troubling set of statistics. They are even more troubling given that EHR documentation errors can sometimes create patient safety problems of their own, especially in fast-moving care settings like the emergency department.

“There are new categories of patient safety errors” taking place in EDs that didn’t exist before EHR use became commonplace, according to Raj Ratwani, scientific director for MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C., who spoke with Kaiser Health News. For example, EHRs that only allow doctors to edit records for one patient at a time can make it harder to track ED patients, according to MedStar physician Zach Hettinger.

Without a doubt, the healthcare industry can’t afford to have its IT infrastructure creating new categories of safety errors or even making mistake-ridden documentation more common. Not only does this defeat the key goals for putting EHRs in place (improving care quality and efficiency), it could lead to a net increase in safety problems.

But as peanut-gallery observers like myself have been shouting for ages, the answer to the problem is fairly straightforward. EHR user interaction design has to be improved dramatically, and soon. This isn’t exactly a secret, but it seems that the issue is still treated largely as an academic discussion rather than one of immediate practical importance for providers.

I’m not sure why we haven’t made more progress on the user experience front in EHR design – or rather, which of the reasons can actually be addressed in our lifetime – but something’s gotta give.

EHRs Don’t Make Errors, People Do

Posted on July 31, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

athenahealth Partners With Quality Group To Research EMR Patient Safety

Posted on November 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While it’s known that EMRs have been involved with, and probably responsible for, patient harm and even death, research is incomplete and sketchy on what risks are the most pressing and how to avoid them. Plus, we’re always balancing these risks with the potential benefits of EMR as well.

One recent study by the Pennsylvania Patient Safety Authority concluded that EMR default settings for medications caused adverse events in more than 3 percent of cases reviewed by the organization.

But that’s just one study, which can only do so much to help on its own. To get a better grip on such issues, EMR and practice management vendor athenahealth has partnered with Patient Safety Organization Quantros to examine the impact that EMRs are having on patient care. The research project is being funded by athenahealth, according to  a piece in Medical  Practice Insider.

athenahealth is offering its national network of about 47,000 providers free access to Quantros’ Safety Event Manager reporting tool, allowing athena’s EMR clients to submit patient safety data directly to the Quantros Patient Safety Center. Delivering the safety data through a PSO like Quantros insulates providers from liability by offering discovery protections when the practices report and analyze a potential issue, Medical  Practice Insider reports.

As one might expect, athena is mounting the experiment to find out when use of its EMR might have contributed to a  potential adverse event, such as, for example, when the EMR fails to warn a physician that a prescribed drug would interact with a drug the patient is already taking.

The bottom line, for athena, is to analyze the data for patient safety trends, and use it directly to improve its technology, said Tarah Hirschey, athena’s senior manager of patient safety, to Medical  Practice Insider.

Study: EMR Default Med Settings Can Cause Harm To Patients

Posted on September 10, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

EMR default settings for medications caused adverse events in more than 3 percent of cases reviewed by the Pennsylvania Patient Safety Authority in a recent study, reports Healthcare IT News.

Researchers with the PPSA analyzed 324 EMR default values (preset medication, dose and delivery) that led to adverse events, in an effort to provide the state’s healthcare facilities with data that could help them avoid such problems. Of the total, six errors were led to what were deemed “unsafe conditions”, while 314 events were reported which generated no known harm to the patient.

Researchers found that the most commonly reported error types were wrong-time errors (200), wrong-dose errors (71) and inappropriate use of an automated stopping function (28).

In theory, default values are there to make medication dosing more standardized and efficient in hospitals. But there are situations in which presets can actually cause harm if they’re not used properly, Healthcare IT News said.

For example, in one report, a patient’s temperature shot up after a default stop time automatically cancelled an antibiotic. In another case, a patient’s sodium levels kept rising because a default note to administer an antidiuretc was marked “per respiratory therapy”; nurses, in response to that note, failed to administer the drug since they incorrectly believed that respiratory therapy was giving the patient the drug.

Another two reports involved temporary harm that called for treatment or intervention by clinical professionals. In one case, a patient got a muscle relaxant dose much higher than intended, and another involved administration of an extra dose of morphine too close to the patient’s last dose.

According to a PPSA statement cited by Healthcare IT News, many of these error reports involved a source of erroneous data, most commonly failure to change a default value or user-entered values being overwritten by the system. Errors also took place when a user failed to enter information completely, which caused the system to insert information into blank parameters.

As useful as these observations are, they just scratch the surface of what can be done to improve EMR safety. Hopefully, the new HHS Health IT Patient Action and Surveillance Plan will address and even cure issues that lie beyond the scope of Pennsylvania’s efforts.