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EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, for HealthLeaders Media, June 26, 2013

"You sigh, recalling the very low cross-reactivity between cefepime and penicillin. When you attempt to order vancomycin: 'Warning! The patient has an adverse reaction to vancomycin. You must enter a reason why you wish to proceed with your order of vancomycin.'

" 'What's that?' you think to yourself. 'Didn't we just do this?' You click to get past the pop-up and order the antibiotic anyway. An hour later, a nurse has turned off the vancomycin infusion, asked you to order diphenhydramine, and is filing an incident report about a preventable adverse medication reaction."

Vendor Recommendations

The report lists seven recommendations, some of which are directed at emergency department information system vendors. They are:

1. Each ED should have a clinician champion to lead a performance improvement group.

2. Such a group should be multidisciplinary, and meet regularly to communicate with ED and hospital leadership.

3. There should be a review process to monitor patient safety issues involving ED information systems, and providers and others should be encouraged to submit safety concerns for review.

4. Providers, vendors, and hospital administrators should address those concerns in a timely manner, with "full transparency, specifically with openness, communication, and accountability."

5. Lessons learned should be measured and shared publicly, including with other EDs using the same information systems.

6. Vendors should learn from patient safety improvements and ensure timely distribution of necessary changes to all installation sites.

7. "Hold harmless" or "learned intermediary" clauses should be removed from vendor software contracts.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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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.