Common Pitfalls Plague Electronic Medical Record Use

A new study assesses the potential harm lurking in the emergency department information system (EDIS), and make recommendations on how to improve patient safety.

Researchers collaborating in a joint effort of the Quality Improvement and Patient Safety Section (QIPSS) and the Informatics Section (IS) of the American College of Emergency Physicians (Irving, TX, USA) conducted a study to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital's or physician group's approach to continuous improvement of the EDIS.

The researchers examined potential EDIS safety concerns regarding communication failure, wrong order-wrong patient errors, poor data display, and alert fatigue, and presented case studies illustrating the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of products in the clinical environment. Following the review, the researchers developed seven recommendations to improve patient safety with respect to the deployment of an EDIS.

These include ensuring that emergency providers actively participate in selection of the EDIS product, as well as in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system's ongoing success or failure. The recommendations apply to emergency departments using any type of EDIS - custom-developed systems, best-of-breed vendor systems, or enterprise systems. The study was published online on June 14, 2013, in Annals of Emergency Medicine.

“The rush to capitalize on the huge federal investment of USD 30 billion for the adoption of electronic medical records led to some unfortunate and unintended consequences, particularly in the unique emergency department environment,” said lead author Heather Farley, MD, of the Department of Emergency Medicine at Christiana Care Health System (Newark, DE, USA). “Some relate to product design, others to user behavior. We offer seven recommendations on how to improve the safety of emergency department information systems, and through their use, patient care.”

The US Health Information Technology for Economic and Clinical Health Act of 2009 and the US Centers for Medicare & Medicaid Services (CMS; Baltimore, MD, USA) "meaningful use" incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic medical records (EMRs).

Related Links:
American College of Emergency Physicians
Christiana Care Health System
US Centers for Medicare & Medicaid Services