For those under the impression that technology will replace doctors, I wouldn’t get ready for the revolution just yet. A new study by a patient safety group has found mistakes and near misses involving electronic health records were analogous to those made with paper-based records with one caveat: Mistakes made with EHRs tend to be amplified and can affect a larger group of people.
The Pennsylvania Patient Safety Authority study looked at 3,099 reports from Pennsylvania hospitals detailing 3,946 problems. More than 2,700 incidents involved near misses and 15 involved temporary harm to patients. The study focused on incidents from 2004 to 2012 in which electronic health records were the root cause in the event, as opposed to being incidental.
Electronic health records are designed to be more efficient than paper-based records, but the two systems have one thing in common: they’re developed and maintained by people. The most common source of problems identified in the study rested with data entry and, to a much lesser extent, with technical glitches.
Medication errors accounted for about 80 percent of the cases or 2,516 reports. About half involved the wrong medication, with about 30 percent involving under-dosing. Another problematic area was lab tests.
One problem is EHRs are connected to other systems like a hospital pharmacy, and they will only get more connected as EHR information is transmitted using health information exchanges. That means that any incorrect information entered in the record gets widely distributed. Another complication is that the deadlines established by the federal government in the stimulus package led to some providers rushing to set up an EHR system without adequate staff training in place.
The study noted that one big problem is several institutions are trying to use paper-based and electronic records in tandem, which creates incomplete information in one source or the other. This issue has led to overmedication in some cases and under-medication in others.
Wrong medication was the number one source of mix-ups, just as with paper-based records. Talking to reporters in a webinar about the study, William Marella, program director for the Patient Safety Authority, said: “There’s no question in my mind that EHR is the smart way to go, but in the short term we are seeing safety issues.” He added that the scale of the problem has changed, so you can have a single problem that can cascade.
Marella recalled one incident from the research for the study in which a technical glitch caused medication orders to randomly appear on some electronic medical records. The problem was not noticed until a request for an erectile dysfunction drug appeared on a female patient’s record. In a separate incident, a note that a patient was allergic to penicillin was made in the free notes section of an EHR rather than in the section addressing allergies. The patient was subsequently given ampicillin, which sparked an allergic reaction.
One way to address the current issues with electronic health records is to make systems smarter, particularly with natural language processing. Such a system could catch information even if it’s not entered in the right place.
The study called attention to the need for tracking the number of near misses and mistakes caused by electronic health records. It pointed out that an Institute of Medicine report called attention to the lack of hazard and risk reporting data on health information technology as a hindering factor in building safer systems.