Docs stress importance of reporting EHR problems

By Molly Merrill
09:30 AM

There's little question that electronic health records reduce adverse drug events and improve quality of care. But that doesn't mean we shouldn't be doing everything to make sure they're as safe and as easy to use as possible, said National Coordinator for HIT, David Blumenthal, MD, at the launch of EHRevent.org, a new safety reporting system that will allow healthcare providers to report adverse issues related to the implementation and use of EHRs.

EHRevent.org "is an important piece of the puzzle to make sure that happens," he said.

The system was launched by not-for-profit iHealth Alliance, which is composed of medical society and professional liability carrier executives in collaboration with federal agencies, and PDR Network, which is hosting EHRevent.org under the guidance of the alliance.

The purpose of the network is to put event reporting is at the fingertips of physicians, says Edward Fotsch, MD, CEO of PDR Network.

This will be done by integrating the system into websites of participating liability carriers, medical societies, regional extension centers, PDR Network and other partners, including EHR system vendors. For example, a participating EHR vendor would have the link to EHRevent.org imbedded in its solution so doctors would only have to click on it to fill out a report form.

The form requires answering nine fields, but allows providers to add more detailed information about the event. This information would then be de-identified and stored in a Patient Safety Organization (PSO), a federally designated entity that would keep the information safe and secure. 

By collecting this information, providers will be able to show trends related to EMR problems rather than just anecdotes, said Nancy Dickey, MD, chair, iHealth Alliance, president, Texas A&M Health Science Center and vice chancellor for Health Affairs, Texas A&M University System.

"This is an opportunity to discern patterns and learn lessons," added Blumenthal, who noted that assuming that it is just the technologies fault is premature, he said.

In fact, said Fotsch, the majority of EHR problems occur during education and training. He said this would be reported under "pilot error." 

David Troxel, MD, medical director of The Doctors Company, a physician-owned professional liability insurer, says he is aware of three EHR related medical malpractice claims that have surfaced recently. Two of the cases suggest problems that occurred during the transition for paper to electronic records. Troxel called this a "perilous period."

"We participated in this system [EHRevent.org] because we all know that any time new technology is adopted there are unintended or unanticipated events that occur," he said.

In both cases physicians were not alerted to the fact that patients had abnormal test results. Troxel said there is always the possibility that key information, when scanned into a patient's record, can get lost. He suspects that the tests were perhaps filed in a folder somewhere else, where the physicians didn't know where to look for it, or weren't scanned into the latest test portion of their records. The result – both patients were diagnosed with advanced cancer.

The third case deals with an independent practice association that negotiated a single EHR contract user agreement for its practices. The unintended consequence was that every doctor in the association had access to each other's patient records – patients they'd never seen, or never would see.

This violates the privacy rules under HIPAA, said Troxel, noting that there's still uncertainty about how to deal with an issue like this one. "[EHRevent.org] can create a mechanism where [physicians] can share problems like this and nip them in the bud early," he said.

"The time is now to collect data," said Lawrence Smarr, president and CEO, Physician Insurers Association of America. EHRevent.org will help us identify, track and address EHR problems, he said.