To service this chaotic environment, many hospitals initially created EHRs that were independent of hospital-wide systems. Since those homegrown ER systems often aren’t compatible with the newer, comprehensive ones hospitals are buying, they’re being phased out.
But the newer EHR models often require adjustments to meet ER needs. “The way the systems are set up, it can actually predispose to higher error rates,” said Dr. Jesse Pines, who directs the Office for Clinical Practice Innovation at the George Washington University School of Medicine in Washington.
While misidentifying patients in this way wasn’t much of an issue before EHRs, it’s “becoming quite prevalent,” in this more digital era, Ratwani said. Many systems, meanwhile, allow doctors to edit the medical record for only one patient at a time, said Dr. Zach Hettinger, who practices emergency medicine at MedStar Union Memorial Hospital in Baltimore. That makes it harder to keep track of things, he said. “You’re stuck with, ‘Do I cancel what I’m in the middle of and not complete that task? Or do I deal with the new task? Do I make a note somewhere—take scrap paper—or just remember it?’ ” said Hettinger, who is medical director of the National Center for Human Factors in Healthcare.
But because doctors don’t decide what a hospital buys, EHR designs often emphasize what administrators or technology officials want, Pines said. To understand ERs, designers must spend time in them, said Dr. Shawna Perry, an associate professor of emergency medicine at the University of Florida Medical College at Jacksonville. “It’s one thing to have a computer and informaticists on your staff, or to have a doctor come in and look at this” particular design feature, said Dr. Robert Wachter, a patient safety expert at the University of California at San Francisco. “It doesn’t get into this issue of what does it look like to be using this system at 4 in the morning, when you have nine other patients and a trauma patient running into the ER, and your beeper’s going.”
This article was produced by Kaiser Health News, a health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation