A new study published in the Journal of Medical Information Association highlights patient safety concerns arising from the massive push to shift hospitals from paper to electronic health records or updating these systems. The causes vary from the way EHR systems display data to insufficient training and modification errors.
Researchers looked at 100 closed safety investigations, spanning from August 2009 to May 2013, reported to the Informatics Patient Safety Office of the Veterans Health Administration. The report reveals four of the most common sources of EHR patient safety problems.
1. Poor display: One of the biggest selling points of EHR systems is that they can draw medical staff’s attention to critical information like drug interactions and allergies. But some EHR layouts mean that info isn’t easy to see — but it goes beyond that. With EHRs, one set of information frequently triggers another response. These complex interactions between the hardware and software, human-computer interface, people, and workflow and communication can mean any errors entered into the computer are even harder to identify and correct. This type of concern accounted for 36 incidents. In one case,a pharmacist entered an incorrect dosage for one medication.
Although a dose error warning appeared on the order entry, users ignored it because it frequently generated false positives. The incorrect dose entry led a nurse, unaware of the discrepancy between the prescribed amount and the amount approved by the pharmacist, to administer the larger dose.
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2. Updating legacy systems and EHR software modification hiccups were the second biggest source of problems and triggered 24 incidents. In one case, a change to a configuring file in the EHR software prevented it from communicating with the printer used to label lab specimens. The printers had been installed before staff members were recruited so it took longer than it should have to identify the source of the problem.
3. Interface shortcomings: The report also drew attention to concerns that information from another patient can be wrongly entered into a patient’s EHR due to interoperability problems between the interface for an EHR and, say, another department. In another situation, a patient who was allergic to ACE inhibitors showed up in the emergency department with high blood pressure, and ACE inhibitors were prescribed, triggering an allergic reaction. Although the patient’s medication allergy list at a remote facility included ACE inhibitors, a network problem prevented remote allergy checking, the report said.
4. Hidden connections: Although this area accounted for the fewest incidents, it could be because the very nature of this problem means it tends to be found by accident. A disconnect between a need and how the software interprets that command can produce big problems. One example given involved a hospital’s blood bank. An algorithm responsible for blood product compatibility matching couldn’t handle an incoming bulk order. It delayed the processing of blood products. This caused a ripple effect and led to disruption of the blood bank workflow. It prevented further entry of blood product orders through the EHR and delayed the release of blood products to the requesting clinical services.
The findings of the report point to a need to constantly assess and troubleshoot for potential problems lurking in EHR systems long after these systems are implemented.
