Patient safety implications of electronic health records

A guest blog by Holly Taylor, RN, BSN, JD, Risk Manager

Have you heard the term e-iatrogenesis? It was first used in a 2007 article to describe patient harm caused at least in part by the application of health information technology (HIT).[1] HIT includes such things as computer physician order entry, clinical decision support systems, electronic health records (EHRs), etc. Evidence is beginning to mount that with the use of EHRs comes the potential for patient harm. Below are some of the issues to be aware of when using EHRs. Each has potential patient safety consequences:

Inappropriate use of templates —Templates are best used for administrative data. One danger with the use of templates is auto-population of data. Auto-populated fields can generate false information. In some systems, default data appears unless actively changed by the user and can lead a user to create false data that becomes part of the medical record.

Almost identical notes —Progress notes that are generated using computer templates produce notes that are so similar it becomes difficult for subsequent providers to parse out the unique (and important) pieces of information from each individual note.

Too much information —With the increasing use of EHRs and the increased connectivity between EHR systems, the amount of patient information a provider has at their disposal has dramatically increased. It can be difficult to sort through volumes and volumes of records to obtain relevant information.

Data entry issues —Two potential issues with data entry are cutting and pasting and data entry errors. Cutting and pasting is fraught with peril. Each entry into the medical records should be independently generated and verified by the person making the entry. Information from prior visits or medical record entries may contain errors that will be perpetuated with cutting and pasting. Drop down boxes, while convenient, increase the risk of inputting incorrect information. A slight slip of the mouse resulting in an incorrect selection can have serious consequences.

Loss of data —A loss of data can have serious implications for both patient safety and in the event of a claim or lawsuit brought against the psychiatrist. Treatment information from prior visits is critical to patient care. Access to the patient record is vital in defending a claim of negligence.

Upgrades and downtimes —Downtimes for software upgrades and/or system maintenance vary according to the type of EHR in use. However, the inability to access patient records, particularly when they contain past histories and physicals, treatment plans and medication lists can negatively affect patient care and safety.

Alert fatigue —Many software programs have alerts designed to inform physicians of potential safety issues. Alert fatigue arises when physicians are bombarded with alerts. These alerts have been shown to frequently contain information that is irrelevant or unnecessary. As frustration grows, even the alerts that are important are disregarded thereby cancelling the very benefit the alerts were designed to provide.

The first step in avoiding the pitfalls of EHRs is to gain an awareness of the risks posed and the potential patient safety implications.  This knowledge can then be applied to practice to ensure safe use of this latest advance in technology.

 


[1] Weiner, J. P., T. Kfuri, K. Chan, and J. B. Fowles. 2007. “E-iatrogenesis”: The most critical unintended consequence of CPOE and other HIT. Journal of the American Medical Informatics Association 14(3):387-388.

Holly Taylor , RN, BSN, JD – Risk Manager – Ms. Taylor received her BSN degree from George Mason University and has worked as a Registered Nurse primarily in hospital settings for more than fifteen years prior to joining PRMS in 2011 as a Risk Manager. She is board certified in pediatric nursing. Ms. Taylor received her JD from George Mason University and was active in the Women’s Law Association and the Trial Advocacy Association. Ms. Taylor’s legal experience includes working on a case involving the merger of two major health care systems and at a law firm defending health care providers and their practice groups from medical malpractice actions. Ms. Taylor recently volunteered in Cambodia and while there wrote the Code of Ethics for Cambodian Nurses.
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