Is Your Electronic Health Record Hazardous to Your Patient's Health?

The Electronic Health Record has the potential of better care through improved legibility, warnings about allergies and drug interactions, improved communication to all providers, artificial intelligence for diagnosis and treatment, e-prescribing with accurate dosages, and improved patient education.

However, as usual the "devil is in the details", which may provide risks to the provider and the patient.

1. Choice of EHR- through meaningful use certification, imposed one-size fits all "enterprise" systems, minimal provider input, and the use of the EHR to attempt to control behavior, collect data, and solve institutional problems- the overall benefits have been neutralized.
2. Implementation- There are multiple articles written on early, middle, and late implementation issues.  Early issues include training, forcing the provider to adapt to the system rather then the rational opposite.  Training teaches you how the software program operates, but does not deal with the actual flow of patient care in the facility.  CPOE is a good example of making the most expensive person in the room a "data technician".
3. CPOE- It was implemented to control costs, decrease errors, and reduce over-ordering of tests.  There is no proof available yet.  However, most CPOE systems lead to more tests, more cook-book treatments and more expense.
4. When the provider is new to the system- lack of intuitiveness of the software, mistakes can easily be made.  A locum tenems provider require training prior to working their first shift!
5. Navigation- Many difficulties exist such as can't find the nursing notes, access old records, access important messages sent to patient, and how to discharge a patient.  Many of these tasks require multiple steps to accomplish something that should be easy and straight-forward.
6. Cooke-cutter charts- The charting output looks the same for every patient due to the use of macros, cut and pasting, and the number of clicks.  The chart becomes disorganized and does not reflect the true problem or treatment plan.
7. Patient Education- the over kill of information that the patient will not read or understand if they do!
8. Pediatric Prescriptions- The difficulty of the overly complex formula that requires a provider to process in a way they were never educated.
9. Artificial Intelligence- Warning fatigue leads to the provider ignoring things that could be significant.
10. Encounter Summaries - Sending a document to a referral provider is complex and over loaded with data that it is hard for the referral provider to determine what has already been done.  Depending on the output, the key information is not always obvious.

Many of the issues listed above force providers to hire scribes and more support personal meanwhile limiting contact with the patient.  They are busy swimming in the overwhelming paperwork!

 

EHR 2.0 will hopefully solve a lot of these issues, but the key is a USER-FRIENDLY version that is viewed as an asset not an obstacle.  Understanding work-flow by the computer developers and eliminating government mandated data collection are excellent first steps!