Patient safety: Advanced EMRs make a difference
The Pennsylvania Patient Safety Authority (PSA), a non-regulatory state agency designed to improve safety in healthcare, has processed 2.25 million reports as part of its mandatory surveillance system. These reports have yielded insight into how advanced EMRs can improve safety in healthcare delivery, said Bill Marella, MBA, program director at PSA.
Marella spoke at the first of 10 scheduled webinars hosted by the Office of the National Coordinator for Health IT on patient safety and health IT.
The PSA’s mission is to reduce medical errors by identifying problems and implementing solutions that promote patient safety, he said. While most states receive data on patient safety incidents on a limited basis through their public health agencies, PSA captures a full range of events. “We analyze reports, put information back out into the community and fund and run collaboratives to work on certain patient safety efforts.”
Marella cited the following most common types of health IT-related patient safety incidents:
- Lab results not transmitted to the EHR.
- Drug orders entered into the wrong patient’s chart
- Progress note copied and pasted into another patient’s chart with incorrect data
- EHR system failure or unavailability
- Wrong drug selected from pick list in CPOE
- Duplicate patient records
“At least as many problems are at the human-computer interface or on the human side of the equation as are attributable to hardware or software problems," he said. This underscores the importance of user-centered design and robust clinical decision support and health IT.
A lot of problems are analogous to errors caused in a paper-record environment. While in that circumstance poor physician handwriting was the root of many mistakes, now it’s choosing the wrong drug from the drug pick list, he said. “I look at health IT as a double-edged sword. As we roll things out, many implementations we’ve seen could stand to be significantly improved.”
Many organizations are looking for more robust, sensitive CDS so, for example, the system will not trigger allergy alerts if the patient already has routinely received a prescription drug. “I think those things are coming.”
Research conducted at the Carnegie Mellon Institute shows that while advanced EMRs have some unintended consequences, they ultimately provide a net positive effect on patient safety, he said.
The institution analyzed adverse events from the PSA, as well as a HIMSS database that ranked organizations' level of EMR functionality. The study took into account several controls, such as inpatient days, teaching status and residency program status, about the institution.
The study found that in the years following EMR adoption, organizations saw a 27 percent decline in all aggregated patient safety events; a 30 percent decline in medication errors; and a 25 percent decline in complications.
“These data suggest that advanced EHRs are a net safety benefit,” he said, but unexpected problems still remain and need to be addressed. “I do feel clinicians’ concerns about EHR usability are genuine and valid.”