Search results for "Electronic Health Records"

Electronic health records (EHRs) offer safety benefits, but the disruption associated with EHR implementation can lead to unintended consequences as well. This observational study sought to determine whether the incidence of adverse patient outcomes (including certain AHRQ Patient Safety Indicators, readmissions, and mortality) was higher at 17 hospitals that were transitioning to a new EHR than in 399 hospitals that did not change their EHR. Investigators found no significant difference between safety outcomes of hospitals with a new EHR and those without a new EHR. This large-scale study across multiple institutions demonstrates that patients' care remains safe during EHR transitions. The authors suggest that these results should allay safety concerns for institutions planning to implement EHRs. A PSNet interview described the challenges associated with EHR transitions.

Electronic health record (EHR) implementation has been linked to physician dissatisfaction and burnout. This survey found physician satisfaction with the EHR decreased immediately after transitioning from a homegrown to a commercial system, and then either remained low or gradually returned to baseline. The authors suggest that these results underscore the need to improve commercial EHRs for physicians.

Compared to paper charts, electronic health records offer safety benefits for physician documentation including better availability and legibility. However, electronic documentation introduces new concerns, such as copy-and-paste practices (which can perpetuate errors) and lack of diagnostic reasoning in electronic notes. This study compared physical exam documentation in initial physician progress notes before and after implementation of an electronic health record. Investigators found more inaccuracies in electronic notes, but more errors of omission in paper charts. Trainee physicians' documentation had fewer errors in both paper and electronic formats. The authors recommend that hospitals discourage copied notes and encourage accurate documentation at the time of the patient encounter. The importance of the physical examination itself was discussed in a PSNet interview with Dr. Abraham Verghese.

This study found that parents of hospitalized children used the Internet-based patient portal and reported high rates of satisfaction. Parents perceived that the portal would reduce medical errors. This work suggests that engaging patients and caregivers via health-related Internet activities could support safe inpatient care.

The effects of electronic health record (EHR) implementation on safety culture are unclear. EHR adoption is disruptive to clinician workflow, affecting work satisfaction and increasing physician and nurse burnout. This could plausibly manifest as worsened safety culture after EHR implementation. In this study, which used AHRQ Hospital Survey on Patient Safety Culture data at 190 hospitals between 2007 and 2011, EHR adoption was associated with mixed effects on safety culture. No overall relationship was found between EHR implementation and safety culture. In fact, fewer patient safety events were reported following EHR adoption, which may reflect safer care or conversely could represent challenges with reporting events in the electronic systems. Early adopters of EHRs did appear to have a stronger culture of safety, but this finding could either mean that EHRs improved safety or that hospitals that emphasized other measures to improve safety culture also tended to adopt EHRs earlier. As this study illustrates, the profound workflow shifts associated with EHR implementation likely induce complex effects that could improve or impair safety. A previous PSNet interview described the role of health information technology in patient safety.

This analysis of incident reports found that problems with handling patient clinical information were a common source of preventable adverse events. These incidents were often due to workarounds, such as recording patient information on paper instead of within the electronic medical record.

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.

Dr. Arora is Director of GME Clinical Learning Environment Innovation and Assistant Dean for Scholarship and Discovery at the University of Chicago Pritzker School of Medicine. We spoke with her about the intersection of health information technology and patient safety.

Electronic health records (EHRs) can improve and hinder the safety of care delivery. This commentary describes how existing data was used to develop a tool to measure unintended consequences of EHRs, which can help inform enhancements to EHR implementation.

Electronic medical records have the potential to improve clinical decision-making by synthesizing patient data over time—for example, by providing graphs showing changes in serial laboratory test results. However, this study found that the graphs in existing electronic medical records were often unclear or misleading, and therefore had the potential to cause diagnostic errors.

In this study, allowing hospitalized patients to access their own medical records as a patient engagement strategy did not increase clinician workload or patient worry, but patients did not identify errors on their medication list or better understand discharge. Although enabling patient access to records in real-time did not have adverse effects, it did not appreciably improve patient safety in this modest sample.

A computerized physician sign-out note embedded into the electronic medical record was designed at Yale–New Haven Hospital to facilitate patient handoffs. This study found that many non-physician health professionals have also been using the sign-out tool, which is felt to be an unintended positive consequence of the system.

Electronic health record (EHR) implementation can be associated with both risks and improvements in safety. This study sought to characterize the positive and negative safety implications of EHR implementation and ongoing use by analyzing interview data from a 30-month evaluation of EHR implementation at 12 sites in the United Kingdom's National Health Service. The study demonstrates how eight specific human–technological factors in a sociotechnical model (people, workflow and communication, internal organizational features, external rules and regulation, measurement and monitoring, hardware and software, clinical content, human–computer interface) come into play in moving health care organizations through three phases of technology implementation. Safety hazards may be introduced in early phases of EHR implementation phases, and inappropriate use of technology as implementation progresses can also result in risks. When EHR use has stabilized, the technology can be used to promote safety.

This ethnographic study used direct observations in 11 primary care clinics with an integrated electronic health record (EHR) to characterize the extent and types of workarounds used by clinicians and support staff. As with prior classic research, the investigators found several different types of paper- and computer-based workarounds, with most being used to aid memory, improve efficiency, or enhance provider awareness of specific clinical problems. For example, several instances of copying and pasting clinical information from note to note were observed, despite this practice being against the institution's policy. Workarounds are generally regarded as representing EHR design failures, but the authors argue that it is unrealistic to expect EHRs to completely obviate the need for paper-based cognitive aids. They advocate for incorporating data on common types of workarounds into human factors–based approaches to improving EHR usability.

Hospitals' use of electronic medical records and computerized provider order entry (CPOE) continues to increase relatively slowly. However, this annual survey of more than 1400 hospitals by the American Society of Health-System Pharmacists found that uptake of medication safety technology has quickened. Half of responding hospitals reported using barcode medication administration, and more than two-thirds use electronic medication administration records and smart infusion pumps. In contrast, a much smaller proportion of hospitals reported using CPOE. These findings indicate that hospitals overall are incorporating new technologies proven to reduce the risk of medication errors.

As they become more prevalent, electronic medical records (EMRs) are being used to improve safety in increasingly creative ways. Recent studies have shown that EMRs can be used to detect diagnostic errors and postoperative complications with accuracy. In this study, the investigators developed an automated method for detecting unapproved abbreviations (UAAs) within clinicians' notes, measured the incidence of UAAs over time, and fed back data to individual clinicians on their use of UAAs. This system resulted in a significant reduction in the use of UAAs over the 6-month study period. Since using UAAs is common and has been linked to serious adverse events, this study demonstrates another potential use of EMRs to improve patient safety.

This magazine article describes problems with medical devices and recommends that device connectivity and integration can improve safety.

This qualitative study identifies user, system, organizational, and environmental factors that help and hinder uptake of electronic health records.

Electronic health records (EHRs) offer great promise in improving patient safety, but remain underutilized in both inpatient and ambulatory settings. While physicians have voiced concerns about EHRs' ability to improve quality of care, this survey found that bedside nurses generally felt that even relatively simple EHRs (including clinical documentation and computerized provider order entry) did in fact improve patient safety. Prior studies have also found that EHRs improve nursing efficiency and the safety of nursing medication administration.

Implementation of electronic health records and computerized provider order entry (CPOE) is considered crucial to overall efforts to improve the quality and safety of care, despite their slow adoption and debated impact. This retrospective study evaluated the role of CPOE and electronic medication administration record (eMAR) use on hospital performance on 11 quality indicators. Compared with non-adopters, hospitals with an eMAR only and with both eMAR and CPOE had higher rates of adherence to quality indicators. Adherence to medication guidelines was also greater in hospitals with longer duration of use with both systems. A past AHRQ WebM&M conversation and perspective discussed computerization in health care, particularly for medication safety.