EHRs pose potential threat to patient safety

Physician complaints regarding the functionality of electronic health records (EHRs) are widespread, and a recent study suggests that those systems pose a potential threat to patient safety.

The study, published in the Journal of the American Medical Informatics Association, analyzed 100 consecutive patient safety reports made to the U.S. Department of Veterans Affairs’ Informatics Patient Safety Office between August 2009 and May 2013. Of those 100 reports, 74 involved unsafe EHR technology and 25 involved unsafe use of that technology.

The safety reports were separated into four categories: unmet data display needs in the EHR; intended and unintended software modifications; concerns related to system-to-system interfaces; and hidden discrepancies within the EHR.

The majority of the safety incidents fell into the unmet data display needs category, where the EHR screen did not show or support the necessary information.

The study’s authors point to an incident where a pharmacist mistakenly entered a higher dose for a diuretic than what had been prescribed. A warning appeared on the EHR screen, but the pharmacist ignored the alert because it was known for being unreliable. The nurse, who administered the diuretic to the patient, could not see the dose discrepancy on the EHR screen.  

Another safety report described an incident where a patient received an angiotensin-converting enzyme inhibitor, despite being allergic, because a network problem prevented providers from viewing the patient’s medication allergy list.

“Our findings underscore the importance of continuing the process of detecting and addressing safety concerns long after EHR implementation and ‘go-live’ has occurred,” the authors wrote. “Having a mature EHR system clearly does not eliminate EHR-related safety concerns.”

The study emphasizes the need for hospitals and practices to conduct regular patient safety risk assessments, even after implementation. “Our study suggests that technology-based solutions alone will only partially mitigate concerns and that interventions to improve EHR-related safety should encompass the people, organizations, systems, and policies that influence how EHRs are used.”

The authors recommend using the SAFER guides released by the Office of the National Coordinator for Health Information Technology.

The researchers recommend that hospitals and practices with long-standing EHRs establish programs to monitor and learn from EHR-related safety concerns.