Study finds EHR implementation still taking too much time, causing serious errors

While physicians have long complained about the administrative burden of EHRs, a new study quantifies some of those concerns and shows how even commonly used platforms can complicate simple tasks.

The study, published last week in the Journal of the American Medical Informatics Association (JAMIA), suggests wide variability in the usability and safety of EHRs.

Researchers observed how long it took four groups of physicians and residents to complete common tasks—like ordering an X-ray or prescribing Tylenol—using EHR platforms made by two major vendors, Epic and Cerner. They also measured how many errors the providers made.

While some tasks were universally quick and error-free, others took up to two minutes and were riddled with errors. When prompted to prescribe the steroid prednisone, tapering over 12 days, half of one group wrote the dose incorrectly.

“There should not be a single system in the country that has an error rate that’s 50% for a taper order,” said the study’s lead author, Raj M. Ratwani, Ph.D., the scientific director and senior research scientist of the National Center for Human Factors in Healthcare at MedStar's Institute for Innovation. 

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The study says the consequences of errors like these range from wasteful (e.g., unnecessary testing) to potentially fatal (e.g., excess radiation exposure or an “inadequate or toxic” course of treatment).  

EHRs are inherently complex, which is part of why they’re hard to use, Ratwani said. In addition to clinical functions, they must include billing features, regulatory components, quality measuring tools, and more. Ironically, these components meant to improve quality may worsen it or reflect it inaccurately.

“[If] it’s confusing to understand what information should be put into the electronic health record, that is going to have unintended consequences,” Ratwani explained. “You may have clinicians and provider organizations that are doing the right things, but because of the way it’s getting input into the EHR, it’s not properly reflecting that.”

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Ratwani warned against packing EHRs full of too many nonclinical functions. In particular, he says data entry around billing and quality measures too often falls to clinicians.

More checks and balances on EHRs' safety are needed, but providers should be proactive as well, according to Hardeep Singh, M.D., M.P.H., chief of the Health Policy, Quality & Informatics Program at the Michael E. DeBakey VA Medical Center. 

"To prevent errors [and] harm from happening," Singh said, "health systems need to invest in programs to analyze and solve errors." He pointed to a study he recently co-authored which found that health systems have not implemented most federal recommendations to make EHRs safer. 

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma has made reducing the burden of medical records a chief priority, launching new initiatives like "Patients over Paperwork" and reworking the Meaningful Use program, now named "Promoting Interoperability." Earlier this month, the agency issued a proposed physician payment rule that reduced the number of documentation requirements and promised to "restore the doctor-patient relationship."

Ratwani says industry collaboration is critical going forward in order to resolve some of the concerns highlighted in the study. 

“We have to work really hard as a community—which includes those developing the technology, the provider organizations and clinicians using the technology, and perhaps most importantly, patients that are going to suffer from the safety issues with the technology—to determine what the level of safety and usability that we’d expect from these systems, and how we are going to get there," he said.