Electronic health records in the ER are prone to human error

This is a good article in the February 29, 2016 issue of Modern Healthcare that talks about the risks of EHRs are accentuated in the emergency department setting. We need to advocated for interoperability so we are not stuck with the systems we have today. We also need to advocate for changes to make the systems safer and more efficient.

From the article in Modern Healthcare

Modern Health Takeaways Poorly designed electronic health record systems are prone to human error, especially in fast-paced emergency room settings.

One of the major promises of the 2009 federal stimulus program that provided financial incentives to hospitals that adopted EHRs was a reduction in errors as they linked physician and hospital patient records. But in ERs, where things often happen fast, the push for interoperability sometimes sets up a technology mismatch that creates challenges that aren’t necessarily as evident in other parts of the hospital.
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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.

In 2013, Pines and other members of the American College of Emergency Physicians wrote a report that found mistakes in the ER—like ordering the wrong medications or, because of confusing computer displays, missing key patient information—were common after the switch to a new digital system. The report suggested many of the mistakes might be the result of poor design rather than user error. “It’s certainly a patient safety concern,” said Dr. Jason Shapiro, an associate professor of emergency medicine at Mount Sinai Hospital in New York, who co-authored the report.
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The ER’s culture and pace can amplify the risks of human error when the EHR is less than user-friendly. Think of the emergency physician who, reaching the end of a hectic 12-hour shift, looks for the record of a patient he just examined. He types in the man’s last name, clicks and writes medical instructions—not realizing that he has pulled up the file of another patient with the same last name and similar age.

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.

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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.”
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