ED electronic health record (EHR) systems have varying functionality that can lead to problems with "physician decision-making, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety," according to a report in the Annals of Emergency Medicine.
The report was written by the American College of Emergency Physicians' work groups on informatics, and quality improvement and patient safety. It details four scenarios in which ED information systems (EDISs) can lead to medical errors:
- Communication failures;
- Poor data displays;
- Wrong order or wrong patient mistakes; and
- Alert fatigue.
In addition, the researchers explained that "[s]ystem functionality varies greatly" among EDISs whether the systems were developed within the hospital, designed by a commercial EHR provider for EDs or are "best of breed" systems.
Obstacles to improvement
The work groups noted efforts to resolve such issues are hindered by:
- A lack of research and evidence of the problems;
- The absence of a mechanism to "systematically allow, let alone encourage, users to provide feedback about ongoing safety issues or concerns"; and
- Contract provisions with EHR vendors that block the flow of information about the programs' safety issues.
Work groups' recommendations
The researchers recommended:
- Appointing a "clinician champion" to oversee the EDIS performance improvement process;
- Creating an EDIS performance improvement group;
- Establishing a review process to monitor ongoing safety issues within EDISs;
- Promptly addressing issues that providers, administration and vendors have identified during the review process;
- Making public lessons learned concerning performance efforts;
- Learning and promptly distributing vendors' patient safety improvements; and
- Removing the "hold harmless" and "learned intermediary" clauses from vendor contracts.
The work groups explained that the "hold harmless" and "learned intermediary" clauses significantly impair efforts to improve patient safety because they create a lack of accountability among vendors and unduly shift liability to clinicians. "[EHRs] and EDISs are sufficiently complex that the physician and other users cannot be expected to anticipate unpredictable errors," they noted (Conn, Modern Healthcare, 6/24 [subscription required]; Goedert, Health Data Management, 6/24).