Inappropriate use of EHR default values harms patients

Using default values in electronic health records can boost efficiencies and standardization, but can cause adverse patient safety events when used improperly, according to a new advisory issued by the Pennsylvania Patient Safety Authority.

The Patient Safety Authority analyzed 324 adverse patient events related to the use of default values in EHRs and computerized physician order entry (CPOE). While 97 percent were events that caused no harm, four resulted in a harmful event, two of which required hospitalization. The most frequently reported event type was medication errors, including wrong time, extra dose, dose omission and wrong dose/overdose.

The study determined that the inappropriate use of default values stemmed, not only from problems originating in the use of EHRs, but also from design problems, such as a user's entry overwritten by the EHR system in favor of a default value or the inability to change a default value.

The Patient Safety Authority recommended that three areas in particular--wrong time errors, errors related to outdated values and errors related to system-entered information--warranted closer attention.

"[T]he default values used in order sets and clinical decision support must match a particular care area's clinical practice in order to be helpful and ... facilities should be wary of wholesale acceptance of default values supplied by the EHR supplier," the Patient Safety Authority stated.

EHR-related patient safety issues have been recognized as a concern; the U.S. Department of Health & Human Services in July issued a health IT safety action plan to attempt to resolve some of these issues.

This is not the first time that the Patient Safety Authority has warned about patient harm stemming from EHR use; it has previously issued warnings about patient harm caused by user error and by the use of hybrid medical record systems.

To learn more:
- here's the advisory