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!

EHR Usability Problems Linked To Potential Patient Harm

Posted on April 9, 2018 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.

If you’re a clinician, you’ve probably always felt that EHR usability problems were a factor in some patient care glitches. Now, there’s some research backing up this hunch. While the numbers of EHR-specific events represented in the study are relatively low, its lead researcher said that it probably underestimated the problem by several orders of magnitude.

The study, which was profiled in the American Journal of Managed Care concluded, that at least some patient safety events were attributable to usability issues. The study, which was just published in JAMA, involved the analysis of nearly 2 million reported safety events taking place from 2013 to 2016 in 571 healthcare facilities in Pennsylvania. The data also included records from a large mid-Atlantic multi-hospital academic medical system.

Of the 1.735 million reports, 1,956 (0.11%) directly mentioned an EHR vendor or product. Also, 557 (0.03%) include language explicitly suggesting that usability concerns played a role in possible patient harm, AJMC reported.

Meanwhile, of the 557 events, 84% involved a situation where patients needed to be monitored to preclude harm, 14% of events potentially caused temporary harm, 1% potentially caused permanent harm and under 1% (2 cases), resulted in death.

The lead researcher on the study, Raj Ratwani, PhD, MA, told the AJMC that these issues are unlikely to resolve unless EHR vendors better understand how providers manage the rollout of their products.

Even if the vendor has done a good job with usability, he suggests, healthcare organizations adopting the platform sometimes make changes to the final configuration during their implementation of the product, something which could be undoing some of the smart usability choices and safety choices made by the vendor. “We really need to focus on the variability that’s occurring during the implementation and ensuring that vendors and providers are working together,” Ratwani said.

Along the way, it’s worth pointing out that the researchers themselves feel that the actual number of usability-related patient safety events could be far higher than the study would suggest.

Ratwani cautioned that he and his team took a “very, very conservative approach” to how they analyzed the patient safety reports. In fact, he suspects that since patient safety events are substantially underreported, the number of events related to poor usability is probably also very understated as well.

He also noted that while the study only included reports that explicitly mentioned the name of the vendor or product, clinicians usually don’t include such names when their writing up a safety report.

EHRs Could Be Causing Patient Harm More Often Than Expected

Posted on December 26, 2017 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.

Why did the healthcare industry invest so heavily in EHRs in recent years?  Obviously, one major reason is the payoffs that became available under HITECH, but that’s not all.

Another important objective for spending heavily on EHRs and other HIT options was to protect patients from needless harm, including everything from clinical decision support to finding grand clinical patterns among patients with similar conditions.

Now, nobody’s saying that none of these benefits have been realized. But according to one researcher, we haven’t paid enough attention to the ways in which these technologies can actually cause harm as well. In fact, some researchers say that HIT-related mistakes are not as minimal or easily managed as some think.

So how do we get a grip on how often HIT tools and EHRs are a factor in patient care errors? One way is to examine the role HIT has played in malpractice claims, which, while not offering a comprehensive look at how such mistakes occur, certainly gives us a look at where some of the biggest have taken place.

For example, look at this data from the Journal of Patient Safety, which dug into more than 300,000 cases from an insurance database to see what role HIT played in such cases. Researchers found that less than 1% of the total malpractice claims involved HIT, more than 80% of that 1% involved problems of medium to intense severity.

The researchers found three major reasons for EHR-related suits:

  • 31% involved medication errors, such as the case when a baby died from a drug overdose that took place because a handwritten order was entered in the computer inaccurately
  • 28% involved diagnostic errors, as when critical ultrasound results ended up being routed to the wrong tab in the EHR — which in turn led to a year-long delay before a cancer patient was diagnosed
  • 31% of cases were related to complications of treatment related to HIT errors. For example, in one case a doctor was unable to access emergency department notes, and the lack of that knowledge prevented the doctor from saving the patient

Unfortunately, if you’re a physician group member working within a hospital — particularly as an on-call clinician with little say about how HIT system should work — your group may be vulnerable to lawsuits due to technologies it doesn’t control.

Still, it doesn’t hurt to learn about common errors that can arise due to EHR and HIT malfunctions. When it comes to delivering patient care, the fewer surprises the better.

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.