Search results for "Electronic Health Records"

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.

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.

Missed and delayed diagnoses are an increasingly recognized patient safety problem. A common undiagnosed symptom in outpatient medicine is chest pain. This retrospective cohort study compared outcomes for three groups of patients with chest pain: those whose pain remained undiagnosed after 6 months versus those diagnosed with either coronary artery disease or a verified noncardiac cause of chest pain. Only a minority of the undiagnosed patients underwent diagnostic testing for coronary artery disease. The highest risk of myocardial infarction was in patients with diagnosed coronary artery disease, but undiagnosed patients were more likely to have a myocardial infarction than those with verified noncardiac disease. The authors conclude that patients without a timely diagnosis merit further evaluation to reduce the risk of cardiovascular events.

Trigger tools facilitate identification of adverse events. In this retrospective medical record review study, investigators found that an automated trigger successfully identified delayed follow-up of laboratory thyroid testing among patients with hypothyroidism, with a positive predictive value of 60%. The authors suggest that this trigger approach could be used to detect and ameliorate follow-up delays in real time.

Diabetes medications are known to be high risk for adverse drug events. This case study reviews several patient safety measures for electronic prescribing for diabetes in outpatient care. Researchers describe an adverse drug event involving electronic prescribing of insulin and detail how the incident could have been prevented. Electronic prescribing is not currently standardized and may require using a trade name for medications, which may lead to prescribing errors. Adoption of the medication naming conventions put forth by the National Library of Medicine's RxNorm would prevent this vulnerability. Similarly, standardizing electronic prescribing orders for high-risk medications like insulin may reduce the risk of erroneously choosing a long-acting instead of short-acting insulin formulation, which can have life-threatening consequences. The authors advocate for using Universal Medication Schedule instructions and providing language-concordant labels to patients to support safe medication self-administration. They suggest that real-time, bidirectional communication between prescribers and pharmacists may improve safe prescribing. The authors conclude that recommended safety practices are not uniformly implemented in clinical practice and advocate for implementation research to ensure medication safety for outpatients with diabetes.

Time spent with the electronic health record and performing administrative tasks has been linked to physician burnout, an important patient safety problem. This study used direct observation and time diaries to characterize the work of outpatient physicians. Investigators found that physicians spent substantially more time on desk work and using the electronic health record than interacting with patients face-to-face.

Dr. Perea-Pérez is Director of the Spanish Observatory for Dental Patient Safety. We spoke with him about patient safety in dentistry.

Implementation of the electronic health record has led to providers engaging in workarounds to circumvent system limitations. This survey found that nearly half of providers at Veterans Affairs medical centers use workarounds when managing test results in the electronic health record. The authors suggest that results management should be improved in future electronic health records and work systems to enhance efficiency and care coordination.

Electronic health records (EHRs) were promoted as a patient safety improvement strategy, but their promise has not been fully realized. Comparing data from an EHR to information from insurance claims, this study found that EHRs inadequately capture mental health care, including inpatient and outpatient visits, medications, and specialty care. This information gap carries significant risk to patients and suggests a need for improved care integration and EHR interoperability.

Enabling patients to access their medical records has been found to enhance patient–clinician communication and uncover errors. This hearing explored the importance of providing patient access to personal health information to improve care. Testimonies discussed the need to have one integrated patient record and to design patient portals around human factors approaches to augment usability.

This observational study of 11 community practices that had integrated behavioral health and primary care describes the challenges related to electronic health records that do not specifically support integrated care delivery functions. There were issues with documentation, tracking, communication, and coordination of care, requiring practices to develop workarounds such as double data entry, scanning and uploading documents, or using separate tracking systems.

A 5-year-old boy with transverse myelitis presented to the rehabilitation medicine clinic for scheduled quarterly botulinum toxin injections to his legs for spasticity. Halfway through the course of injections, the patient's mother noted her son was tolerating the procedure "much better than 3 weeks earlier"—the patient had been getting extra injections without the physicians' knowledge. Physicians discussed the risks of too-frequent injections with the family. Fortunately, the patient had no adverse effects from the additional injections.

Failure to follow-up on test results in ambulatory practice is a common, serious safety concern. This study examined the use of a results manager tool by primary care physicians in Partners Healthcare in Boston. Although the vast majority of providers used the tool, many did not find that it was helpful for any specific purpose and only 64% were satisfied with the tool.

This survey of more than 1700 physicians in ambulatory practice found generally positive perceptions of electronic health records (EHRs), with approximately 80% reporting that EHRs enhanced the overall quality of care for patients. Respondents also noted safety benefits, with two-thirds reporting that the EHR alerted them to a potential medication error.

More than half of older adults offered access to personal health records (PHRs) logged on at least once, but frequent use was rare. While users reported improved medication reconciliation and safety behaviors, there was no difference in use of inappropriate medications or adherence measures compared with patients who had no access to PHRs.

This ethnographic study used direct observation to characterize how users of an electronic health record compensated for perceived system deficiencies.

Delayed diagnoses in cancer may commonly be caused by cognitive errors or logistical breakdowns. These delays can lead to poor patient outcomes and are a frequent cause of malpractice lawsuits in the ambulatory setting. In this study, four electronic triggers were developed to detect patients at risk for delayed diagnosis of prostate and colorectal cancers. The algorithm identified patients with elevated prostate-specific antigen levels, positive fecal occult blood tests, iron-deficiency anemia, or bright red blood per rectum, but automatically excluded those that already received appropriate care or had known terminal illnesses. The positive predictive values for each these triggers were between 58% and 70%, providing a reasonably accurate report of patients that truly lacked appropriate follow-up. The American Medical Association has identified better follow-up of abnormal test results as a key area for improving patient safety in the ambulatory setting.

The Health Information Technology for Economic and Clinical Health Act recently catalyzed the adoption of electronic health records (EHRs) in both hospital and ambulatory settings. Overall, EHRs have positively affected patient safety, but this effect has been inconsistent. This qualitative study explored whether differences in individual physicians' traits affected their EHR-use patterns in the ambulatory setting. Physicians were categorized as either "uncertainty reductionists," "uncertainty absorbers," or "uncertainty hybrids," based on how they viewed the role of patient information in the medical record and how they handled uncertainty. Physicians who viewed uncertainty primarily as reducible through information ("reductionists") tended to be high EHR users; whereas, those who acknowledged irreducible uncertainty in caring for patients ("absorbers") were mostly low EHR users. These findings have implications for future EHR implementation and training efforts. Dr. David Blumenthal discussed health information technology adoption in an AHRQ WebM&M interview.

Electronic medical records (EMRs) are generally perceived to improve patient safety, and prior reviews have found that EMR implementation is associated with improvement in some measures of safety and quality. This study of EMR implementation in a large primary care medical group found a positive association between implementation of a new EMR and safety culture, with sustained improvement in Safety Attitudes Questionnaire scores over a 3-year period following implementation. Interestingly, the perceived improvement in safety culture was smallest in the first year of use of the new EMR; a prior study found that 1 year of experience was necessary before primary care physicians felt a new EMR improved safety and quality.

An elderly man presented to an emergency department (ED) with new onset chest pain. In reviewing the patient's electronic medical record (EMR), the ED physician noted a history of "PE," but the patient denied ever having a pulmonary embolus. Further investigation in the EMR revealed that, many years earlier, the abbreviation was intended to stand for "physical examination." Someone had mistakenly copied and pasted PE under past medical history, and the error was carried forward for years.