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EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, for HealthLeaders Media, June 26, 2013

"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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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.