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Search results for "Electronic Health Records"

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Newspaper/Magazine Article

Study: clinicians copy and paste about half of text in EHR progress notes.

Landi H. Healthcare Informatics. June 1, 2017.

The use of copy and paste is a popular time-saving mechanism to update electronic medical documentation, but this practice can introduce risks. This news article reports on various resources that explore problems associated with the copying and pasting in electronic health records, including a recent study that highlighted how this practice can perpetuate incomplete or wrong information into patient records.

Journal Article > Study

Implications of electronic health record downtime: an analysis of patient safety event reports.

Larsen E, Fong A, Wernz C, Ratwani RM. J Am Med Inform Assoc. 2017 May 30; [Epub ahead of print].

When electronic health records are out of use, either for planned upgrades or because of unexpected malfunction, this downtime disrupts usual hospital workflow. This study conducted an automated text search to identify incident reports related to electronic record downtime and analyzed the selected reports. Electronic health record downtime led to issues with laboratory testing including specimen identification errors and delayed transmission of results. Medication administration errors were also prevalent during downtime. Researchers found that downtime could hinder patient identification and information availability, which may result in serious safety hazards. The authors advocate for development of more comprehensive downtime procedures to address safety concerns as well as more consistent adherence to existing procedures.

Journal Article > Commentary

Emerging from EHR purgatory—moving from process to outcomes.

Goroll AH. N Engl J Med. 2017;376:2004-2006.

Electronic health records can both contribute to and detract from patient safety. This commentary discusses how the physician payment system hinders the development and innovation needed to enhance the ability of electronic health record systems to deliver on promises of improved safety and quality.

Journal Article > Study

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records.

Walker AS, Mason A, Quan TP, et al. Lancet. 2017 May 9; [Epub ahead of print].

The weekend effect (higher mortality for patients in acute care settings on weekends compared to weekdays) has led to widespread concerns about hospital staffing. This retrospective study examined whether mortality for emergency admissions at four hospitals in the United Kingdom differed on weekends compared to weekdays. Unlike prior studies of the weekend effect, this study included multiple specific markers of patients' illness severity as well as hospital workload. Investigators found higher mortality associated with being admitted to the hospital during weekends compared to weekdays, but a significant proportion of the observed weekend effect was explained by severity of patient illness. They used three measures to approximate hospital workload: total number of admissions, net admissions (subtracting discharges from admissions), and percentage of beds occupied. None of these workload measures was associated with mortality. The authors conclude that differences in illness severity rather than health care team staffing explain the weekend effect. A recent PSNet interview discussed the weekend effect in health care.

Journal Article > Study

Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review.

Stockton KR, Wickham ME, Lai S, et al. CMAJ Open. 2017;5:E345-E353.

An accurate list of patient medications is a necessary precursor for safe medication use. One strategy to improve medication reconciliation is to provide a list of dispensed outpatient medications to inpatient clinicians upon hospital admission via an electronic medication reconciliation process. This retrospective chart review study compared a research pharmacist–generated gold standard medication list to the actual medications ordered during an admission after such a process was implemented. The study team identified medication discrepancies between the pharmacist-generated and admission-ordered medication lists and noted any inappropriately prescribed or continued medications. Medication errors were present in nearly half of the patient records; about 9% of errors were clinically important. The authors raise concerns that electronically prepopulated medication reconciliation forms may actually adversely impact medication safety. A previous WebM&M commentary discussed how to enhance accuracy of medication reconciliation.

Journal Article > Study

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

Adelman JS, Berger MA, Rai A, et al. J Am Med Inform Assoc. 2017 Apr 17; [Epub ahead of print].

Wrong-patient errors can occur during computerized provider order entry, particularly if ordering clinicians have more than one patient record open. Experts have recommended that health systems allow only a single patient record to be open at a time to prevent these errors. This national survey of electronic health record leaders examined whether health systems permit records for multiple patients to be open simultaneously for electronic ordering and documentation. Nearly 200 health systems responded to the survey, and respondents described widely differing practices. Among health systems where clinicians could open multiple patient records at a time, the common justification was to support efficiency. A significant proportion did impose a restriction of working on one patient record at a time, and a smaller group limited clinicians to working with two open patient records only. These results suggest that further study of the optimal number of open patient records is needed to balance safety and efficiency in completing electronic health record work.

Journal Article > Study

Innovative use of the electronic health record to support harm reduction efforts.

Hyman D, Neiman J, Rannie M, Allen R, Swietlik M, Balzer A. Pediatrics. 2017;139:e20153410.

The Centers for Medicare and Medicaid Services no longer reimburses hospitals for certain hospital-acquired conditions—an increasingly recognized source of preventable harm to patients. Researchers describe how they were able to reduce harm resulting from hospital-acquired conditions at their institution by more than 30% through improved use of electronic health record data and reporting tools.

Cases & Commentaries

Patient Allergies and Electronic Health Records

  • Web M&M

Matthew J. Doyle, MBBS; April 2017

Prior to undergoing a CT scan, a patient with no allergies documented in the electronic health record (EHR) described a history of hives after receiving contrast. During a follow-up clinic visit, the patient inquired whether this contrast reaction was listed in the EHR. Investigation revealed that it had been removed from the patient's profile, thus leaving the record with no evidence of allergy to contrast.

Journal Article > Study

The impact of electronic medical records on hospital-acquired adverse safety events: differential effects between single-source and multiple-source systems.

Bae J, Rask KJ, Becker ER. Am J Med Qual. 2017 Apr 1; [Epub ahead of print].

Electronic health records enhance patient safety, but they also have unintended consequences. This retrospective study found that hospitals with a single-source electronic health record were less likely to have hospital-acquired safety events compared to hospitals with multiple systems in place. These results suggest that safety gaps may arise at the interface of multiple electronic systems.

Journal Article > Study

Association between elements of electronic health record systems and the weekend effect in urgent general surgery.

Kothari AN, Brownlee SA, Blackwell RH, et al. JAMA Surg. 2017;152:602-603.

This statewide, retrospective cross-sectional study identified longer than expected length of stay for urgent surgical procedures on the weekend compared to weekdays. Hospitals with electronic operating room scheduling and electronic bed management systems were less likely to demonstrate the weekend effect. These results suggest that health information technology can be employed to mitigate the weekend effect.

Journal Article > Study

Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations.

Carayon P, Wetterneck TB, Cartmill R, et al. J Patient Saf. 2017 Feb 28; [Epub ahead of print].

This human factors study examined how electronic health record (EHR) implementation affected medication safety. Researchers encountered improvements in transcription, dispensing, and administration errors after EHR introduction. Several types of medication prescribing errors, including choosing the wrong drug, duplicate orders, or orders with incorrect information, increased with EHR use. This study adds to the evidence suggesting EHR implementation has mixed effects on medication safety.

Journal Article > Study

Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.

Savage EL, Fairbanks RJ, Ratwani RM. J Am Med Inform Assoc. 2017 Feb 19; [Epub ahead of print].

Poor usability of electronic health records is a patient safety concern. This qualitative study found that usability policies from the Office of the National Coordinator for electronic health records are less prescriptive about testing final products and rely more on attestation, compared to the Food and Drug Administration's usability policies for medical devices or the Federal Aviation Administration's usability policies for avionics. The authors suggest that other agencies' usability policies could inform federal efforts to enhance electronic health record usability.

Journal Article > Study

Screening electronic health record–related patient safety reports using machine learning.

Marella WM, Sparnon E, Finley E. J Patient Saf. 2017;13:31-36.

Voluntary error reporting systems are an important part of safety improvement programs, but difficulty in analyzing error reports has limited their utility. This study described the development of a machine learning algorithm to analyze free-text data in incident reports. The algorithm proved to be accurate in classifying events when compared to manual review.

Journal Article > Study

Meaningful use of health information technology and declines in in-hospital adverse drug events.

  • Classic

Furukawa MF, Spector WD, Limcangco MR, Encinosa WE. J Am Med Inform Assoc. 2017 Feb 16; [Epub ahead of print].

Electronic health records have both safety benefits and unintended consequences. This analysis used data from the 2010–2013 Medicare Patient Safety Monitoring System to compare the incidence of in-hospital adverse events among hospitals that did and did not meet meaningful use requirements for health information technology (IT), according to the Healthcare Information Management Systems Society Analytics Database. Investigators found that hospitals that met meaningful use criteria also reported fewer adverse events. Although the study design does not establish a causal relationship between implementation of health IT and the decline in adverse events, the authors argue that these advances in health IT contributed to this patient safety improvement.

Journal Article > Commentary

Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy.

Schreiber R, Sittig DF, Ash J, Wright A. J Am Med Inform Assoc. 2017 Feb 16; [Epub ahead of print].

Lack of interoperabilty and user errors are safety concerns associated with the use of electronic health records (EHRs). This case report provides two examples of problems with order cancellations in EHRs due to ineffective interfacing of systems that led to gaps in care. The authors recommend that hospitals test new information technologies to help identify weaknesses and make the ordering process safer.

Audiovisual > Audiovisual Presentation

A National Web Conference on Improving Health IT Safety Through the Use of Natural Language Processing to Improve Accuracy of EHR Documentation.

Agency for Healthcare Research and Quality. February 7, 2017.

Incomplete clinical notes create potential for treatment errors. This webinar discussed voice-generated electronic records as a strategy to augment clinical documentation and highlight natural language processing technologies as a component of this strategy.

Journal Article > Study

The evolving role of medical scribe: variation and implications for organizational effectiveness and safety.

Woodcock DV, Pranaat R, McGrath K, Ash JS. Stud Health Technol Inform. 2017;234:382-388.

The use of scribes, nonclinical staff who aid clinicians by entering information into electronic health records (EHRs), has increased markedly in the past few years. This qualitative study used interviews with clinicians, administrators, and scribes to develop a sociotechnical framework for the role of scribes with relation to the EHR. A prior commentary suggested that scribes represent a workaround that may inhibit the development of more advanced and user-friendly EHRs.

Journal Article > Study

Improving communication with primary care physicians at the time of hospital discharge.

Destino LA, Dixit A, Pantaleoni JL, et al. Jt Comm J Qual Patient Saf. 2017;43:80-88.

Adverse events after hospital discharge are common. Prior research demonstrates that communication and information transfer between inpatient providers and primary care physicians (PCPs) may be lacking, raising patient safety concerns. This study described how applying Lean methodology, enhancing frontline provider engagement, and redesigning workflow processes within the electronic health record led to improved communication with PCPs around the time of hospital discharge. Through these interventions, the pediatric medical service was able to increase verbal communication with PCPs at discharge to 80%, and they sustained this for a 7-month period. Discharge communication with PCPs across other services improved as well. A previous PSNet perspective discussed the challenges associated with care transitions and suggested opportunities for improvement.

Book/Report

Examining the Copy and Paste Function in the Use of Electronic Health Records.

Lowry SZ, Ramaiah M, Prettyman SS, et al. Gaithersburg, MD: National Institute of Standards and Technology, United States Department of Commerce; January 19, 2017. NIST Interagency/Internal Report (NISTIR)-8166.

Copying and pasting information in electronic health records can introduce risks. This report discusses a human factors study of the phenomenon to determine how the practice affects information distribution. The authors conclude that the problem does exist, describe its impact on situational awareness, and provide recommendations to improve safety associated with the copy-and-paste function.

Journal Article > Study

Improving patient safety: avoiding unread imaging exams in the National VA enterprise electronic health record.

Bastawrous S, Carney B. J Digit Imaging. 2017;30:309-313.

Inadequate test result management is known to contribute to missed and delayed diagnosis. This Veterans Affairs study found that 0.17% of radiologic studies were not evaluated by radiologists. The study team identified several technical and process problems that contributed to these unread studies. They were able to address the issues to ensure all studies were read.

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