EHR Design Flaws Contribute to Patient Harm in the ED
"It doesn't promote patient safety if you can't talk about it. And if you do something that changes the EHR in a good way, you should be able to publish that so it can be disseminated to other systems."
The silence has prevented quantification of the problems that might provoke the vendors to make their systems more foolproof, Pines says.
Kevin Baumlin, MD, vice chair of the emergency department and director of informatics at Mount Sinai Hospital in New York who is a member of the ACEP panel, emphasized that there's no question electronic health records have improved healthcare.
In one example, clinical decision support at his hospital has "saved 70 lives" of patients with severe sepsis, simply by triggering earlier recognition of the problem and thus, earlier rescue.
"But the reason why we're going through this process (installing EHR systems) is to reduce our errors, not make more of them. We wrote this article to say, 'Hey, let's be careful we're not creating a whole different set of errors while we're getting rid of old errors and error types."
The report outlines four types of "pitfalls" commonly seen in EHR systems and makes seven recommendations to address the issues.
1. Communication Failure
A physician may enter into the electronic record an order that he or she already gave the nurse verbally, thereby inadvertently giving the patient more than the intended dose. The report gives this example:
"The loud moaning draws you into room 10, where you find a patient rocking back and forth, holding his right flank. 'He says it is his kidney stones,' informs the nurse. After a cursory examination, you ask the nurse to give him 1 mg of hydromorphone to ease his obvious discomfort. You then receive an urgent request to reevaluate a critical patient. Finally, you sit down at a computer station to chart and enter orders for the patient with a presumed kidney stone.
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