EHR Customization Can Result in Medical Errors, Incomplete Testing and Certification

While widespread adoption of electronic health records (EHRs) has helped put them in an overwhelming majority of hospitals and clinics, their design and function could cause medical mistakes and errors unless more rigorous voluntary and mandatory testing of systems becomes the norm, a new report found.

The national push to implement EHRs was motivated, in part, because EHRs were intended to improve medical safety as well as efficiency in hospitals, clinics, and pharmacies. Electronic records would put an end mistakes caused by providers’ inability to read physician handwriting, for example. Meaningful use, the federal program designed to increase EHR adoption required vendors and providers to do testing to ensure they meet certification and safety criteria. However, a report written jointly by the Pew Charitable Trust, the American Medical Association, and MedStar asserts that the design, customization, and use of EHRs by doctors, nurses, and other clinicians can also lead to inefficiencies or workflow challenges and can fail to prevent—or even contribute to—patient harm, the report states.

“For example, an unclear medication list could result in a clinician ordering the wrong drug for a patient. Laboratory tests that are displayed without the date and time of the results could lead to clinical decisions based on outdated information. And failures of systems to issue alerts about harmful medication interactions—situations that can stem from changes made by facilities, how clinicians enter data, or EHR design—could lead to medical errors.”

A key concern for the report writers is the customization that takes place once a system is implemented in order to be tailored to specific workflows. Customized EHRs frequently don’t resemble the original version, and safety is often not re-evaluated.

Pew, MedStar, and the AMA convened a literature review and an expert panel of physicians, nurses, pharmacists, EHR vendors, patients, and health information technology experts, which resulted in:

  • Recommendations on how to advance usability and safety throughout the EHR software life cycle, which can be used as the foundation for a voluntary certification process for developers and EHR implementers.
  • Criteria detailing what constitutes a rigorous safety test case and the creation of sample test case scenarios based on reported EHR safety challenges.

Click here to read the full report.

Mary Butler is the associate editor at Journal of AHIMA.

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