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EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, for HealthLeaders Media, June 26, 2013

Errors in patient care, attributed to electronic health record systems used in emergency departments, are "incredibly common," says a researcher. But vendor contracts prevent physicians from speaking publicly about problems with the systems.

Patients are being subjected to treatment mistakes and harm because of design problems in electronic health record systems now being rolled out in the nation's emergency rooms. But emergency department doctors are powerless to correct these flaws because of gag clauses that prohibit them from publicizing the issues.

Those are among several key findings in a report released Monday by 15 members of an American College of Emergency Physicians [PDF] panel who say hospital administrators have rushed to buy systems from major EHR vendors to get incentive payments without considering the ED.

When inpatient systems are introduced to different emergency room processes, emergency physicians' input is not sought in advance, leading to major functional problems impeding good care.

Asked if emergency room electronic health record errors cause frequent errors in patient care and even harm, Jesse Pines, MD, Office for Clinical Practice Innovation director at George Washington University and the report's senior author, replied:

"Based on anecdote, it's incredibly common… If you ask any ED provider if they've had any of these events happen in the last six months, my guess is that universally, it will be rare to find someone who hasn't seen an issue, a near miss or actual error that's occurred."

The problem with quantifying such events, Pines says, is that "the way the vendor contracts are set up, they do not allow the users to really speak publicly about their individual system…to expose any of these issues. So one of the recommendations of this panel was to take these clauses out of these contracts."

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3 comments on "EHR Design Flaws Contribute to Patient Harm in the ED"


Pat (7/2/2013 at 2:24 PM)
Nowhere in this report do I see the nursing side of it all expressed. We find things every day that we intervene for before they happen. Human error is present of course, but most of these problems are generated because of the electronic charting. Please include nurses when you look at these problems. They are the ones who are having to deal with catching problems, etc. Several problems required communication but the electronic chart is not the panacea for quality care that everyone wanted it to be. Nurses are so often left out of the equation and they are the key to patient care.

Grif (6/26/2013 at 1:30 PM)
This article brings up some good points, however, the majority of the issues the author attributes to an EHR system are simply brought on by human error. The seven suggestions showcase this fact by primarily addressing preventive actions the ED could be taking.

Mary K (6/26/2013 at 11:39 AM)
The example given for "1. Poor Communication" is incredibly bad. The only time a provider should be giving a verbal order is in case of an emergency (e.g., running a code). Pain for a kidney stone does not equate to an emergency (although it raises everybody's stress levels and it FEELS like an emergency). This is a COMPLETE BYPASS of patient safety[INVALID][INVALID]there is no written order, there is no way for the nurse to verify allergies, to verify the medication and dosage, and how can s/he document giving the dosage if it was verbal? I would not want to be treated in this ED because staff are taking shortcuts in the pretext of alleviating suffering.