This appeared last week:
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support
Author affiliations
Abstract
Background Electronic health records (EHR) can improve safety via computerised physician order entry with clinical decision support, designed in part to alert providers and prevent potential adverse drug events at entry and before they reach the patient. However, early evidence suggested performance at preventing adverse drug events was mixed.
Methods We used data from a national, longitudinal sample of 1527 hospitals in the USA from 2009 to 2016 who took a safety performance assessment test using simulated medication orders to test how well their EHR prevented medication errors with potential for patient harm. We calculated the descriptive statistics on performance on the assessment over time, by years of hospital experience with the test and across hospital characteristics. Finally, we used ordinary least squares regression to identify hospital characteristics associated with higher test performance.
Results The average hospital EHR system correctly prevented only 54.0% of potential adverse drug events tested on the 44-order safety performance assessment in 2009; this rose to 61.6% in 2016. Hospitals that took the assessment multiple times performed better in subsequent years than those taking the test the first time, from 55.2% in the first year of test experience to 70.3% in the eighth, suggesting efforts to participate in voluntary self-assessment and improvement may be helpful in improving medication safety performance.
Conclusion Hospital medication order safety performance has improved over time but is far from perfect. The specifics of EHR medication safety implementation and improvement play a key role in realising the benefits of computerising prescribing, as organisations have substantial latitude in terms of what they implement. Intentional quality improvement efforts appear to be a critical part of high safety performance and may indicate the importance of a culture of safety.
Here is the conventional link:
This article makes is clear that in hospital use of electronic medical records with clinical decision support (CDS) and with medication management can reduce (by 50-70%) adverse medication events but can by no means eliminate such errors.
One can assume I believe similar benefit from CDS with GP prescribing but just what part the #myHR plays – lacking either prescribing or CDS – is likely to be very minor indeed!
Physicians make errors prescribing and unless you have interactive CDS at the point of actual prescribing you won’t make much difference in reducing error. As such the #myHR is really not in the hunt in this aspect of prescribing error reduction.
Another reason the #myHR is not much of an idea, compared with some alternatives!
David.
Gee, has anyone wondered if a hospital environment is the same as "in the wild"?
ReplyDeleteIn hospital, the patient is in bed, is fed medication and food, is constantly monitored and is undergoing treatment.
At home, things are just a little bit different. You don't suppose that's relevant?
Context based??? Hmmm computer says no
ReplyDelete