With limited data available on potential safety risks related to EHRs, the Pennsylvania Patient Safety Authority has published one of the largest compilations of safety issues related to EHRs in Pennsylvania healthcare facilities in its December Pennsylvania Patient Safety Advisory released today.
"When most people talk about the safety of health IT, they're thinking of software bugs, hardware failures, or network problems. But our data show issues that are much more about the human-computer interface or the ways healthcare providers interact with the technology," Bill Marella, program director for the Pennsylvania Patient Safety Authority, said. "While electronic health records will be the source of many improvements in the long run, in the short run it's clear they are not a panacea for patient safety problems."
Of the 3,099 EHR-related events analyzed by the Authority, 2,763 (89 percent) were reported as "event, no harm," meaning an error occurred but there was no harm to the patient. Ten percent of the reports (320) were reported as "unsafe conditions," which also did not result in a harmful event. Fifteen reports involved temporary harm to the patient due to the following: entering the wrong medication, ignoring a documented allergy, failure to enter lab tests and failure to document.
Marella said the Authority's data is among the first large-scale examinations of these types of errors. Recently, the Institute of Medicine released a report, Health IT and Patient Safety: Building Safer Systems for Better Care, which notes a lack of hazard and risk reporting data on healthcare information technology as a hindering factor in building safer systems. Pennsylvania is the only state agency collecting this volume of data about EHRs.
"With the rapid adoption of electronic health records in the healthcare industry, there is growing concern that safety is not at the top of the agenda," Marella added. "The Authority study gives not only Pennsylvania healthcare facilities, but all healthcare facilities implementing this technology, a glance at the potential problems they should anticipate and monitor after implementation."
Since the Health Information Technology for Economic and Clinical Health Act (HITECH Act) legislation was signed into law in 2009, the healthcare industry is pushing to implement EHRs to collect financial incentives as part of the American Recovery and Reinvestment Act of 2009, the federal economic stimulus bill. Financial incentives will be offered until 2015.
"Among the problems this study identified," Marella said, "are data entry errors not caught by the system, data entered into wrong fields, misreading or misinterpreting displayed information and providers incorrectly accepting default values when entering orders."
Marella added that problems related to wrong input (1,867) spanned a wide range of event types and outcomes: transposition or transcription errors in the entry of orders or administration information, entry of incorrect patient parameters (like weight or blood glucose) that trigger calculations of incorrect therapy, and even entry of the wrong physician name, resulting in reports being sent to the wrong recipient.
"Overall, almost four thousand problems were identified in the little more than three thousand reports analyzed. This analysis lays the groundwork for more focused studies of individual EHR safety issues," Marella said.
For more information about the EHR study, go to the December Pennsylvania Patient Safety Advisory article "The Role of the Electronic Health Record in Patient Safety Events," on the Authority's website at www.patientsafetyauthority.org.