EHRs must be able to anticipate, handle present and future crises

Electronic health records have the potential to improve patient care for problems we can predict, such as reducing urinary tract infections and identifying patients who haven't received their flu shots.

But they still appear to be unable to handle some of the more current and unanticipated medical problems, and that should give everyone pause.

Just look at this week's news. Opioid misuse and abuse is one of the biggest health epidemics in this country. It's become such a large concern that the Department of Health and Human Services' Office of Inspector General added the issue to its 2016 work plan.

But a new study reports that a commercial EHR's clinical decision support tool in a hospital's emergency department (ED), designed to issue alerts when opioids are prescribed, was so poorly calibrated that it triggered at unnecessary and clinically insignificant times. The "overwhelmed" providers sorted through 4,692 alerts to avert 38 adverse drug events, which translated to dealing with more than 123 unnecessary alerts to prevent one adverse drug event. Only eight adverse drug events involved an opioid, and none were prevented by the EHR's alert. To top it off, more than 96 percent of the alerts ended up being overridden. That's a lot of alert fatigue.

So much for using that EHR to deal with opioids. The researchers suggested that the alert undergo some serious tweaking. And although they didn't say it, the fact that they identified the EHR as being a commercial product indicates that this problem likely can be found in other hospitals.

Then there's Geisinger Health System's initiative to use its EHR, combined with diagnostic interviews, to identify specific genetic risk factors to determine which reservists and National Guardsmen are at higher risk of post-discharge behavior health conditions, such as traumatic brain injury, depression, post-traumatic stress disorder and substance abuse. The tool that will be generated is expected to facilitate appropriate therapy.

It's a wonderful idea, but overall, the track record of EHR systems when it comes to supporting behavioral health isn't really up to snuff. While it has been established that integrating physical and mental health records improves patient care, many EHRs aren't designed to handle behavioral health information. And since there are still barriers to interoperability, as well as strict federal laws regarding confidentiality of substance abuse records, it can be difficult, if not impossible, for providers to share this information with each other.

And that's only if the patients can even obtain behavioral health treatment. That still eludes many, despite increased recognition that more patients than ever--including many veterans--need this help.

Opioid abuse and behavioral health issues present constant challenges for patients, providers and caregivers. Why, then, are the EHRs so inflexible and behind the times that they can't handle them?

If we're going to rely on EHRs, then these systems need to be on the top of their game. They need to be reliable and flexible. They need to be able to handle, not only current medical crises, but future unforeseen issues, as well. - Marla (@MarlaHirsch and @FierceHealthIT)

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