Tuesday, January 24, 2012

More On The Possible Risks Associated With EHRs. The US AMA Releases a Report!

The following appeared a week or so back on one of our favourite topics.

EHRs Linked to Errors, Harm, AMA Says

Clinicians can introduce errors when they copy and paste sensitive patient data into electronic health records, according to AMA research.
By Ken Terry,  InformationWeek
January 13, 2012
A new AMA report on patient safety in ambulatory care finds that safety problems are widespread but that little is known about which problems cause the most harm. Among the uncertainties cited by the AMA researchers is the contribution of electronic health records (EHRs) to patient safety.
"The use of electronic health records has the potential to improve patient safety and early research shows some promise, but these systems have also been linked to errors and harm," the report says. "It is not yet clear how many providers will adopt these systems, nor the extent to which health IT will improve patient safety in ambulatory care versus generating new types of errors."
The report cites studies indicating that EHRs encourage providers to "copy and paste" clinical data and that they support "automatic behavior" rather than careful reasoning and analysis. Poorly designed systems with hard-to-use interfaces, data entry errors, and software configuration issues can also endanger patients, the report noted.
David Classen, MD, a consultant to the AMA on the report, told InformationWeek Healthcare that the researchers took no position on EHRs, pro or con.
"That study was looking at the evidence from a scientific point of view and finding there is still very limited evidence that EHRs improve the safety of care in the average doctor's office," noted Classen, who is also a CSC consultant and an associate professor of medicine at the University of Utah School of Medicine.
Most safety studies, Classen pointed out, have been conducted in large healthcare systems and academic medical centers. That's true, for example, of studies showing the positive effects of electronic prescribing and test ordering in ambulatory care settings. "So we really don't know what's going on in the regular physician's office."
More is found here:
This is the link to the AMA report:
The additional information panel contains a link to the full report:

Top six errors in outpatient care

A decade of research shows that these errors are the most widely documented in ambulatory care, leading to hospitalizations, complications, minor physical harm, psychological harm, lost patient pay, physical injury and death.
  • Medication errors such as prescriptions for incorrect drugs or incorrect dosages.
  • Diagnostic errors such as missed, delayed and wrong diagnoses.
  • Laboratory errors such as missed, delayed and wrong diagnoses.
  • Clinical knowledge errors such as knowledge, skill and general performance errors on the part of physicians and other clinicians.
  • Communication errors such as doctor-patient communication errors, doctor-doctor communication errors or other miscommunications between parties.
  • Administrative errors such as errors in scheduling appointments and managing patient records.
Source: "Research in Ambulatory Patient Safety 2000-2010: A 10-year review," American Medical Association, December 2011 (www.ama-assn.org/resources/doc/ethics/research-ambulatory-patient-safety.pdf)
With this we also had a contribution on how to use EHR’s more safely.

CCHIT chair: Tips to use EHRs to improve safety

By mdhirsch
Created Jan 18 2012 - 9:37pm
How well can your EHR system protect patients from substandard patient care? Evidently quite a bit, according to Karen Bell, chair of the Certification Commission for Health Information Technology (CCHIT).
Bell, citing a recent report from the Institute of Medicine (IOM) calling for better patient safety in HIT, notes that providers should consider patient safety when evaluating and using EHR systems. While there is no one assessment tool that providers can use to test EHRs regarding safe care, providers can take practical steps to see if their EHRs include the most up-to-date functions and features to improve patient safety--and to check whether the providers are using them.
Bell's checklist is an excellent resource for providers shopping for and implementing EHR systems.
......
To learn more:
- here's Bell's
full list [1] of suggestions
- read the IOM
report [2] (.pdf)
More here:
and almost in the same breath we have this.

EHRs lacking in adverse drug event detection

By mdhirsch
Created Jan 18 2012 - 9:32pm
Many studies confirm that electronic health records enhance patient care, reduce costs or provide some other benefit. But sometimes a study reveals that EHRs--and, fact, the studies testing the EHR systems--have design flaws.
That's the conclusion of a recent study of EHR adverse drug event (ADE) detection systems published by the Journal of American Medical Informatics Association. ADEs, adverse patient outcomes caused by medications, are common and difficult to detect, and occur in 6.5 percent of hospitalized patients, which makes them a major threat to patient safety.
The researchers theorized that electronic alerts to detect ADEs showed promise, since they would be faster, cheaper, objective and more accurate than other detection methods, such as manual chart review. The study analyzed prior studies of electronic systems that automatically screened for ADEs from hospital pharmacy, laboratory, radiology and administrative departments.
The results were not positive. Electronic detections were only 50 percent accurate, and for some EHRs "quite low," according to the researchers.
......
To learn more:
- read the study's
abstract
More here:
Here is the direct link to the abstract:
The abstract conclusion is pretty worrying:
“Conclusion
Several factors led to inaccurate ADE detection algorithms, including immature underlying information systems, non-standard event definitions, and variable methods for detection rule validation. Few ADE detection algorithms considered clinical priorities. To enhance the utility of electronic detection systems, there is a need to systematically address these factors.”
All in all these studies and articles continue to re-enforce the view that just implementing technology is not of itself a ‘good thing’. Much more careful thought, design and evaluation of all interventions is required before mega adoption.
PCEHR Program are you listening? On the basis of what we have seen today I suspect not!
David.

4 comments:

Anonymous said...

As this is a US article the term EHR refers to the in house medical records solution. We usually refer to this as an EMR in Australia. It is not referring to a SEHR or a PHR.

In Australia we have a significantly higher penetration of EMR solutions. It is important that corresponding research is done in Australia.

ADE detection is nothing to do with the PCEHR. It is a local system function.

Dr David More MB PhD FACHI said...

"ADE detection is nothing to do with the PCEHR. It is a local system function." Very much agreed - but if you listen to the twaddle peddled by NEHTA and DoHA they do their best to confuse and elide just what functions are where and which part does what!

What we have heard in the last 24 hours makes it clear to me safety is not a major quality driver of the PCEHR Program - rather the main driver is satisfying nonsensical political time tables.

David.

InformaticsMD said...

Re: "David Classen, MD, a consultant to the AMA on the report, told InformationWeek Healthcare that the researchers took no position on EHRs, pro or con."

That is part of the problem. Why don't they take a position when the literature is conflicting on benefits and harms, and the US Institute of Medicine indicates the level of risk and harm is unknown?

That is not the setting for national rollouts; the ethical position is to have a position - one emphasizing caution.

-- SS

InformaticsMD said...

And by the way, Bell's article is a "it's good to use sterile technique in surgery" type of article.

Why are such articles still needing to appear in print after 30+ years of a Health IT industry?

-- SS