Emergency department EHRs 'particularly error prone'

Electronic health records provide many benefits, but also bring about "unintended consequences" of errors that can affect patient safety in the emergency department, according to a new article in the Annals of Emergency Medicine.

The article, a joint effort by members of two workgroups of the American College of Emergency Physicians (ACEP), notes that emergency department information systems (EDIS) are an "important" and "unique" component of the movement to improve quality ad outcomes with EHRs.

However, according to the authors, the unique characteristics of emergency departments--such as the rapid turnover, frequent transitions of care, interruptions, variation in patient volume and unfamiliar patients--make these EHRs particularly error prone. Some of the biggest problems outlined involved communication errors, poor data display, wrong order-wrong patient errors and alert fatigue.

To combat these problems, "active engagement by front-line clinicians in improving these products is critical," the authors said. They made seven recommendations, including: 

  • Appointment of an emergency department "clinician champion"
  • Creation of a multidisciplinary EDIS performance improvement group
  • Establishment of an ongoing review process
  • Timely attention to EDIS-related patient safety concerns raised by the review process
  • Public dissemination of lessons learned from performance improvement efforts
  • Timely distribution by EDIS vendors of product updates to all users
  • Removal of "hold harmless" and "learned intermediary" clauses from all vendor software contracts.

Patient safety issues arising from EHRs use have received much attention since the Institute of Medicine published a report on the subject in late 2011. In response, the U.S. Department of Health & Human Services issued a draft health IT patient safety plan last December.

What's more, the HIMSS EHR Association recently released a vendor code of conduct that encourages vendor participation in patient safety initiatives.

To learn more:
- read the article abstract