EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, 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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