EHR-related patient safety problems persist 'long after' implementation

Electronic health records create a rife of patient safety problems that linger well after implementation, according to a new study in the Journal of the American Medical Informatics Association (JAMIA).  

The researchers studied 100 closed investigations involving 344 technology-related incidents that occurred between 2009-2013 in 55 U.S. Department of Veterans Affairs (VA) facilities. The VA has been operating VistA, its EHR system, for many years, as well as a non-punitive voluntary system that enables users to report EHR patient safety concerns.

The study found that three-fourths of the investigations involved unsafe technology, such as design issues. Most incidents (70 percent) involved a mix of two or more problems, and a whopping 94 percent of the safety concerns related to four issues:

  • Unmet data display needs
  • Problems with software upgrades and modifications
  • Transmission of data within the EHR
  • "Hidden dependencies" within the EHR that affected different components of the EHR, such as medications being automatically removed from an inpatient's active medication list because they were previously ordered while the patient was an outpatient

Patient safety issues arising out of EHR use have been identified as an unintended consequence of the shift to EHRs. The Office of the National Coordinator for Health IT is in the process of creating a health IT safety center to improve patient safety and facilitate voluntary reporting of EHR-related patient incidents.

Poor EHR design is one of the most troubling aspects of patient safety, according to David Troxel, medical director of the Doctors Company, a medical malpractice insurer.

"This study identified several potential patient safety issues related to electronic health records," Troxel said in a statement emailed to FierceEMR. "For example, one aspect of EHRs, drug-drug interaction lists, generates frequent, annoying, and disruptive alerts, and doctors may develop "alert fatigue" and ignore, override, or disable them. If it can be shown that following an alert would have prevented an adverse patient event, the physician may be found liable for failing to follow it."

The researchers found that "even within a well-established EHR infrastructure, many significant EHR-related safety concerns related to both unsafe technology and unsafe use of technology remain." They also suggested mitigating procedures that could improve patient safety, such as testing information displays in the context of "real world" tasks, using unambiguous words in system messages, and exploring the impact of changes on workflows.  

To learn more:
- here's the study

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