Growing Concerns about Electronic Health Records and Safety

Posted on Jan 10th, 2013 at 9:10am.

In mid-2012 I sat at a dinner table with a half-dozen practicing physicians who are also quality leaders in their organizations. I asked them if the EHR, as currently being implemented in their setting, was making their care (in their own personal practices) better, or worse. Every single one said “Worse.” When asked “Why?” their most poignant examples dealt with the loss of meaningful clinical narrative in the blither of cut-and-paste documentation, They also complained of the substitution of screen time with computers for “touch time” with patients. And they all had examples of medication and diagnostic errors that seem to have been caused, rather than prevented, by the EHR.

Which brings me to the most disturbing document I’ve read this year: Health IT and Patient Safety, the IOM report released in November 2012. In this report, the nation’s top health IT experts were asked the same question that I asked the practicing doctors: “Is the EHR making care more safe, or less safe?” The experts’ answer appears to be “Uh, we’re not sure, but we’re worried.” That’s not very reassuring, especially since safety has been a primary target of EHR implementations since their early development.

The IOM report describes tremendous variation from one institution to another in how the EHRs of the same vendor have actually been implemented, with dramatically different impacts on safety. Furthermore, in conversations with David Classen and other notable experts, I’ve also learned about some rather alarming results of field tests of whether EHRs would “catch” incorrect medication orders. No one’s EHR caught more than 80% of the test examples, and many caught only 20% of them. Furthermore, no one vendor was any better than any other, and the range of 20%-80% was seen across various institutions that were using the same vendor! And this sort of thing—drug/drug interactions, dose adjustments for patients with renal failure, drug allergies….was supposed to be the strength of the EHR!!

I think all health care leaders should read the report, and then engage in a serious conversation with their nurses, doctors, pharmacists, vendors, and IT specialists to ask themselves whether their own EHR is making care better or worse. Far too much money is being spent hurtling toward “meaningful use” if it isn’t going to achieve meaningful improvements in safety.