Providers need recourse regarding EHR defects

It's always great to read about the successful implementation of an electronic health record system, like this story published last week in Inside Tucson Business. After all, transitioning to an EHR is expensive and time consuming. If you're going to adopt an EHR--and that is the direction the healthcare industry appears to be moving in--the process should be as smooth as possible.

It's equally disheartening, however, to read the opposite kind of story. Blogger Rich Just posted this week about his practice's struggles with its EHR system: a glitch causes notes to disappear, sometimes to another section of the chart, sometimes into oblivion. According to Just, the practice discovered that the glitch occurred when physicians started the note before entering the vital signs, so now they can avoid the glitch. Still, despite vendor support, it can't be removed. 

It's bad enough that EHRs have design flaws such as usability problems, or backfiring features that impede workflow and functionality. But software glitches that lose data, cause the system to go down regularly and create other havoc really are inexcusable. They're also apparently rather common.

A Google search of "EHR horror stories" came back with a whopping 51,800 results. Granted, not every horror involved "glitches", but that's still a huge number. And those are just the ones reported on the Internet.   

So what's a hospital or physician to do?

There are some precautions that providers can take to avoid buying a problematic EHR system, of course. For instance, they can check out the KLAS rankings on EHR products, conduct research online, confer with colleagues, ask a vendor for a satisfaction and money back guarantee, and the like.

None of those, though, can assure that an EHR will be glitch-free--or that a glitch won't develop, such as during an upgrade; and all EHRs will need to be upgraded to be able to meet the upcoming Stage 2 of Meaningful Use.

So why not resurrect two concepts that have been discussed for years but never implemented?

The first is creating a one-stop repository that providers and others can report on EHR systems and vendors, good and bad. The American Medical Association has toyed with the idea. If Angie's List can rate painters and doctors, why not EHR vendors and their systems, too?

Or perhaps the list should be government sanctioned. The Institute of Medicine recommended months ago that a new watchdog agency be created and operated by the U.S. Department of Health & Human Services to oversee the safety of EHRs and other health IT. This oversight would include registration of EHR products, monitoring of health IT-related errors, and investigations of adverse events related to the systems. This has yet to occur, despite a Congressional call for follow-up.

Note that this oversight need not be limited to major patient safety problems; arguably even EHR "glitches" can and do adversely affect patient safety and treatment. If the Consumer Product Safety Commission can list product recalls and safety alerts on its website, HHS can do the same.

The second is extending lemon laws to EHR purchases. This seems really overdue. An EHR is an expensive, technologically sophisticated product, as is a car; if it repeatedly fails to meet the standards of quality and performance, despite attempts by the EHR vendor to correct the problem, a provider should have the right to replace the system or return it for a refund.

Enough is enough. - Marla

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