Emergency department electronic health record 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 published in the current edition of Annals of Emergency Medicine, Modern Healthcare reports.
The report -- titled "Quality and Safety Implications of Emergency Department Information Systems" -- was written by the American College of Emergency Physicians' work groups on informatics, and quality improvement and patient safety (Conn, Modern Healthcare, 6/24).
The report details four scenarios in which EDISs can lead to medical errors, including:
- Communication failures;
- Poor data displays;
- Wrong order or wrong patient mistakes; and
- Alert fatigue (Goedert, Health Data Management, 6/24).
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 (Modern Healthcare, 6/24).
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 (Health Data Management, 6/24).
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 (Modern Healthcare, 6/24).