EHRs can magnify impact of small mistakes

The advantages of EHRs also can become their biggest liability. According to a review by the Pennsylvania Patient Safety Authority, mistakes and near misses involving EHRs were similar to those made with paper-based records except that EHRs tend to cause those mistakes to grow and affect more people.

The review looked at 3,099 reports from Pennsylvania hospitals detailing 3,946 problems. More than 2,700 incidents involved near misses and 15 involved temporary harm to patients. The study focused on incidents from 2004 to 2012 in which EHRs were the root cause in the event, rather than being incidental.

“The majority of EHR-related reports involved errors in human data entry, such as entry of ‘wrong’ data or the failure to enter data, and a few reports indicated technical failures on the part of the EHR system. This may reflect the clinical mindset of frontline caregivers who report events to the Authority,” according to the review.

Medication errors accounted for about 80 percent of the cases, or 2,516 reports. Many of the remaining 20 percent involved lab tests. About half of the drug errors involved the wrong medication, with 30 percent classified as underdosing.

EHRs are connected to other systems such as a hospital pharmacy, which will only become more connected as patient data from EHRs is transmitted using health information exchanges. So, any incorrect information entered in the record is widely distributed and impacts every subsequent interaction.

Deadlines established by the federal government in the 2009 economic stimulus package led to some providers rushing to set up an EHR system without adequate staff training in place, according to the review. The study also noted that trying to use paper-based and electronic records in tandem is very problematic, creating incomplete information in one source or the other. This issue has led to overmedication in some cases and underdosing in others.

While the review was “performed to inform the field about the types of EHR-related errors and problems reported to the Pennsylvania Patient Safety Authority,” more important may be the intention of it “to serve as a basis for further study.”

The review is available online.