A Swift Transition from Paper to Digital
A decade ago, patients would rarely see a doctor with a tablet or laptop during an appointment. The doctor would scribble notes and pass them along to a nurse or clerk, who would in turn file away the notes in a paper records system.However, as the Boston Globe explains in a recent report, things changed in 2009 when the Obama administration and Congress pushed through $30 million in taxpayer subsidies to incentivize doctors and hospitals to convert to digital systems.
The percentage of doctor’s offices in the U.S. using EHRs nearly tripled over a five-year span, going from 17 percent in 2008 to 42 percent by 2013. Among U.S. hospitals, the percentage skyrocketed from 13 to 70 percent over that same time span, the newspaper reports.
One problem that has resulted from this swift transition from paper to digital: In some facilities, the transition has not been a complete one. The Globe article describes these as being “hybrid” paper/digital systems.
These systems can lead to medication errors such as the tragic story reported by the newspaper about a woman who received a fatally high dose of insulin at a Boston area hospital.
According to the newspaper, nurses at that facility had been acting on insulin orders that were entered in two prescribing systems – one paper, one digital – and under different doctors’ names.
Types of Medical Errors Associated with EHRs
The ECRI Institute listed “data integrity failures in EHRs and other health IT systems” at No. 4 on its list of the “Top 10 Health Technology Hazards for 2014.”
The non-profit organization noted the importance of accurate information being entered into EHR systems so that doctors can provide appropriate treatment. Any breakdown in the process could lead to disastrous results.
Unfortunately, those breakdowns often occur. The ECRI Institute described common EHR-related errors as being:
- Basic data entry errors
- Copying-and-pasting errors, including putting old data in a new report
- Missing or delayed entry of data
- Errors stemming from lack of clock synchronization
- One patient’s records being mistaken for another patient’s records.
Design flaws and software glitches account for many of these issues. Human errors do as well. As The Globe reports, staff may override automatic warnings and come up with ways to work around the digital obstacles they encounter while rushing to use the system and get back to tending to patients.
A Mandatory Reporting System Is Needed
Mandatory reporting standards for medical errors in the EHR industry would help hospital officials and patient safety experts learn what is wrong with the EHR systems and develop solutions. Unfortunately, no such reporting system exists, and resistance to such mandatory measures is strong, according to The Globe.
As the newspaper reports, neither the U.S. Food and Drug Administration (FDA) nor the U.S. Department of Health and Human Services (HHS) have indicated any desire to provide oversight of EHR systems or to create a mandatory system for reporting EHR-related injuries and deaths. The health IT industry has lobbied against a mandatory system by asserting that, due to fear of repercussions, hospital staff could actually conceal errors instead of reporting them.
In the absence of a much-needed reporting system, we can turn to voluntary reporting. We can also turn to our civil justice system.
For example, The Globe report contains statistics provided by a Harvard-affiliated malpractice insurance group. By combing through a database of 5,700 malpractice cases, the group identified 147 EHR-related “adverse events,” including 46 that resulted in deaths, over a one-year period.
Thus, by seeking to hold hospitals accountable for EHR-related errors, medical malpractice claims can shed light on a growing problem in our hospitals and, hopefully, contribute to changes that ultimately enhance the safety of patients.
Author: Patrick A. Salvi
