Path to improved EHR safety requires collaborative research

Electronic health records have not made as much progress in patient safety as the industry had hoped, which has spurred a "reinvigorated" need for improvement, according to a new editorial in BMJ Quality and Safety.

The transition to EHRs has not been easy, notes Thomas H. Payne of University of Washington Medical Information Technology Services in Seattle, with usability problems and increased administrative burdens, despite expectations of improved patient safety.

Unfortunately the latter has not occurred, Payne says.

Problems he identifies include bias in reporting errors in self-reporting systems, the fact that some clinical support services are too simple, and that some items, such as problem lists, are not used. The EHRs and computer physician order entry (CPOE) systems also are not designed to catch some of these errors, he says. Many of the errors with health IT were identified years ago but were not used to leverage improvement.

However, Payne suggests that rather than "lose hope" and be pessimistic about the lack of progress, this should be seen as an opportunity to improve health IT safety now.

"EHRs won't improve unless we study them, collect data on what went wrong, and--importantly--resolve to use those data to make the EHR systems better," he says. "This work can't be left to entirely to EHR vendors, and should occur in a framework to ensure that the most pressing issues are tackled first."

EHR-related patient safety issues have long been recognized as an "unintended consequence" of the use of such systems. The U.S. Department of Health and Human Services has issued a health IT safety action plan to attempt to resolve some of these issues, and the Office of the National Coordinator for Health IT has released a set of guides to help providers improve patient safety when using the systems. 

The Agency for Healthcare Research and Quality also is funding research on the subject.

To learn more:
- read the editorial

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