EHR inaccuracies threaten patient safety

Electronic health records are not doing a good job of creating accurate and clear graphs of patient information, which may adversely impact patient safety, according to a new article in the Journal of the American Medical Informatics Association (JAMIA).

The researchers, from the University of Texas Health Science Center, Baylor College of Medicine and elsewhere, evaluated the graphical displays of lab test results in eight EHRs. They used 11 objective criteria, such as title of graph, legends, and x and y axis scales and labels. Six of the EHRs were certified by the Office of the National Coordinator for Health IT, one was an EHR prototype and one was the U.S. Department of Veterans Affairs' EHR system.   

The results were discouraging. There was little standardization among the graphs, and none of them met all 11 criteria; three of them only met five criteria, according to the authors. One plotted data in reverse chronological order, and one plotted data at unequally spaced points in time. Three didn't display the patients' IDs directly on the graph, and only two allowed users to see, hover over or click on a data point to see values of x and y coordinates. 

The authors expressed particular concern with the results because the U.S. Food and Drug Administration has recently proposed that EHRs don't need any additional administrative oversight.

"Many current commercial EHRs have significant limitations in graphing capabilities of laboratory test results and often display results in nonstandardized fashion," the authors said. "Accurate display and interpretation of clinical laboratory test results is essential for patient safety. EHR-generated graphs often provide important diagnostic clues, such as downward hemoglobin trends with gastrointestinal bleeding, increasing creatinine levels with renal failure on nonsteroidals, or rising prostate specific antigen levels suggestive of prostatic disease."

The researchers recommended that clear and accurate visual display of lab data be ensured through ONC's certification testing process, and that providers be alerted to this issue so they better understand what the EHR graphs represent.

This is hardly the first time that EHRs have been associated with safety problems. The Health and Human Services Department and others have attempted to address the problem, but more research is needed to make meaningful progress in this area.

To learn more:
- here's the study