Study: Emergency Department EHR Design Can Lead to Errors

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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).

EDIS Pitfalls

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).


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