Government, industry need to act to avoid 'unintended consequences' of EHRs

A combination of government oversight and industry action is needed to avert the "unintended consequences" of electronic health record use that adversely impact patient safety, according to Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association.

Bowman, writing in AHIMA's Perspectives in Health Information Management, warns that shortcomings in EHR design and implementation create not only safety, fraud and abuse problems, but also may serve as a barrier to EHR use and adoption. 

"Although many system developers and policy makers believe that the risks of EHRs are minor and easily manageable, that is not the case," Bowman says. "Patient safety and quality of care are seriously compromised by flawed EHR system design or functionality or improper use. Failure to address information integrity issues in EHR systems will lead to spiraling, rather than declining, healthcare costs and medical errors as a result of the proliferation of new types of patient safety hazards."

Several of Bowman's recommendations include:

  • Regulation and better scrutiny of EHR systems
  • A greater focus on usability and proper use
  • Improvement of documentation capture processes, such as defined EHR content standards and "ethical" documentation
  • Implementation of processes to promote safety of clinical-decision support systems
  • Required reporting of EHR-related adverse events

EHR-related patient safety issues have long been recognized as a concern. The U.S. Department of Health & Human Services published a health IT safety action plan in July to attempt to resolve some of these issues. The HIMSS Electronic Health Record Association's vendor Code of Conduct, published in June, also focuses on EHRs and patient safety. However, neither the HHS plan nor the Code of Conduct call for new regulations or required reporting of adverse events, both of which have been recommended by the Institute of Medicine.

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