EHRs contribute to increased ED mistakes

Errors in hospitals emergency departments (EDs) are rising with the increased use of electronic health records, according to a new Kaiser Health News article.


EHRs provide some benefits, such as easier access to data and elimination of concerns with physician handwriting. However, EHRs also are creating "new categories" of patient safety errors stemming from both design issues and human error. Two examples include:

  • Information being input into the wrong patient's chart
  • The wrong medication dosage being provided to a patient

There are several particular concerns with EHRs in the ED, according to the article. For instance, the culture and pace of an ED is different from the rest of the hospital. It's much faster, and clinicians are juggling many patients at once.

EDs also have a different workflow, and EHRs for them evolved separately, mostly home grown. As hospitals move to newer, hospital-wide EHR systems, new commercial products don't necessarily fit the ED, creating both the need to adjust them and a technology "mismatch" that causes challenges not necessarily apparent in other hospital departments.

The systems also cause clinicians to resort to ineffective workarounds. For example, since only one record can be edited at a time, some clinicians use paper notes or rely on their memories and input the information later.

In addition, some of the systems were designed without much clinician input, although several vendors interviewed indicated that they include physicians in the design process. 

One provider, however, believes that patient safety problems likely will decrease as the industry matures.

"Think about where we were even 30 years ago with cars. Cars are rapidly innovating to become safer and more efficient--and I think we can expect to see the same transformation in the electronic health record space," Jesse Pines, director for the office for clinical practice and innovation at George Washington University School of Medicine, told Kaiser Health News. "Things are improving. And things will continue to improve."

EHRs are known to both reduce and increase adverse patient events. The Government Accountability Office reported recently that even pulling the data from EHRs to identify adverse events is a key challenge in reducing such events.

To learn more:
- read the article