Patient Safety and Electronic Medical Records

A good report from Kaiser Health News on what doctors in the trenches deal with regularly: "EHRs In The ER: As Doctors Adapt, Concerns Emerge About Medical Errors".

Here's the introduction:

The mouse slips, and the emergency room doctor clicks on the wrong number, ordering a medication dosage that’s far too large. Elsewhere, in another ER’s electronic health record, a patient’s name isn’t clearly displayed, so the nurse misses it and enters symptoms in the wrong person’s file.

These are easy mistakes to make. As ER doctors and nurses grapple with the transition to digitalized record systems, they seem to happen more frequently.

“There are new categories of patient safety errors” in emergency rooms that didn’t exist before the push to use electronic record systems, said Raj Ratwani, who researches health care safety and is the scientific director for MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C.

Spurred by the 2009 stimulus package and the 2010 health reform law, the federal government has offered hospitals financial incentives to adopt electronic health records that, among other things, will add efficiency and reduce errors by linking physicians’ patient records, and coordinating and tracking how care is delivered across the health system. Hospitals that don’t meet those standards are hit with penalties...

In other words, EHRs were rammed down the throats of doctors and hospitals, rather than being allowed to be integrated organically according to the best judgments of the end users.

Imagine how user friendly your smart phones would be, if you had to buy one (rather than choosing whether or not to get one.)

Unfortunately, patients will pay the price:

The ER’s culture and pace, for instance, can amplify the risks of human error that stem from an already less user-friendly system. Think of the emergency physician who, reaching the end of a hectic 12-hour shift, looks for the record of a patient he just examined. He types in the man’s last name, clicks and writes medical instructions — not realizing that he’d accidentally pulled up the file of another patient with the same last name and similar age, who was admitted five minutes before.

While misidentifying patients in this way was hardly an issue before EHRs, it’s “becoming quite prevalent,” in this more digital era, Ratwani said.

For now, this means patients will have to be extra-diligent in confirming that the data in their health records is accurate. And that any prescriptions or treatments they receive actually make sense.

Most doctors try their best take good care of their patients. It's unfortunate when government technology mandates makes that job that harder, not easier.