Patient safety joins list of EHR concerns

We have often commented on studies that show low physician productivity and frustration with electronic medical records, and how difficult it is to quickly get the key facts needed in the clinical trench. These are common themes.

Now a new concern has emerged with this far-reaching technology: patient safety.

In “An analysis of electronic health record-related patient safety concerns” by The Institute of Medicine published in JAMIA (the Journal of the American Medical Informatics Association) the authors conclude:

Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.

But human beings always have a role to play and are part of the complex equation leading to both good and bad care decisions.

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.

Modern Medicine in its coverage of the study (see “Complicated, confusing EHR pose serious safety threats” – you’ll need a free login to read it) quotes author Dr. Hardeep Singh: “It’s not just the technological complexity, it’s also the social aspect around technology.”

The article uses a great example of this: a pharmacist makes a data entry error and inputs a higher dose of a diuretic than normal. A warning appears on his screen that is known to have a high false-positive rating, so the pharmacist overrides the warning and the incorrect dose is subsequently administered to the patient.

Even the most sophisticated EHR implementations should continuously monitor for safety issues, the authors advise.

Marla Durben Hirsch at FierceEMR has also summarized the report in “EHR-related patient safety problems persist ‘long after’ implementation” as well as reviewing the controversy around the ONC’s polemical IT health and safety center.

Our takeaways:

  • Poor user experience design and extraneous information contribute to safety concerns
  • Humans/technology interaction works best when each provides the right checks and balances
  • EHRs once deployed need continuous improvement to make it easier for humans to do their part