By Christine Kern
A new study urges caution when implementing EHRs.
A recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs), and a new study published by the Journal of Medical Information Association highlights those concerns arising from the massive push to shift hospitals from paper to electronic health records or updating these systems. The causes vary from the way EHR systems display data to insufficient training and modification errors.
The study extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70 percent) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94 percent) safety concerns related to either unmet data-display needs in the EHR, software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.
The report reveals four of the most common sources of EHR patient safety problems:
- Poor display: One of the biggest selling points of EHR systems is that they can draw medical staff’s attention to critical information like drug interactions and allergies. However, some EHR layouts mean that info isn’t easy to see, and with EHRs, one set of information frequently triggers another response. These complex interactions between the hardware and software, human-computer interface, people, and workflow and communication can mean any errors entered into the computer are even harder to identify and correct. This type of concern accounted for 36 incidents.
- Updating legacy systems and EHR software modification hiccups were the second biggest source of problems and triggered 24 incidents. In one case, a change to a configuring file in the EHR software prevented it from communicating with the printer used to label lab specimens. The printers had been installed before staff members were recruited so it took longer than it should have to identify the source of the problem.
- Interface shortcomings: The report also drew attention to concerns that information from another patient can be wrongly entered into a patient’s EHR due to interoperability problems between the interface for an EHR and, say, another department.
- Hidden connections: Although this area accounted for the fewest incidents, it could be because the very nature of this problem means it tends to be found by accident. A disconnect between a need and how the software interprets that command can produce big problems.
According to the report, EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA.
The findings of the report point to a need to constantly assess and troubleshoot for potential problems lurking in EHR systems long after these systems are implemented. And the researchers concluded that, because EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them.
