The article EHR safety goes to court discusses a hospital system suing
an EHR provider over lack of support due to several safety issues. The issue
is complicated by the fact that one provider was purchased by another and then
the hospital contracted with a third party. Both claim breech of contract and
the hospital system states that patients were harmed.
How
were they harmed? There were errors in tracking of patient locations, discharge
medications, and there was a general inability to properly use the Computerized
Order Entry system (CPOE). These suits
demonstrate that factors such as lack of usability, poor interfaces, poor
training, and poor support, inevitably lead to errors. Compound that with the
prevalent practice of having non-clinical, non-computer savvy, individuals
input sensitive and tricky clinical data, and there is an ever-present recipe
for disaster. Why can’t clinicians be counted on to input the data themselves? Because clinicians really don’t have the time
or capacity to deal with poorly designed systems that do not function smoothly
and intuitively; caring for patients, rather than nursing IT systems, is their
main priority.
The
article states: “For
years, many patient safety advocates have warned that EHR systems carry
numerous potential risks due to their poor design and the ease with which data
entry errors can lead to medical mistakes. “ The reality is that highly
pressured providers have to make multiple clicks, leading to an exponential
rise is the potential for error. Rarely are real-time checks and balances built
in, so that a person in-putting data has little, if any, verification, that “STAT
ORDERS,” for example, were received and/or acted upon.
Anyone
who has attended a risk management or critical incident committee meeting in
the E HR era is well aware of the many system based medical errors that arise
because of the functionality or lack of functionality of the programs and
people interacting with them. Humans !System-Based Medical Errors” inevitably lead to litigation that pits provider, hospital, and vendor against one another in a complex legal battle. In general, of course, there is no easy resolution as each side can easily point to the weakness of the other parties.
Moreover, lawyers, doctors, and healthcare systems can count on the fact that there will be competing vendors waiting in the wings with baited breath to take over any system wherein complaints are rising. In this case Epic took over a Cerner client; but in others Cerner has taken over an Epic client. This juggling occurs across the board. It is almost (but not quite) as bad a politics. There are promises, promises. Oh! The promises. Most often disregarded (or masked) is the fact that experience shows the same complaints regarding the old system will appear in the newly installed system in short order. The political metaphor aside, it is not unlike the story of Sisyphus; the Greek Titan who rolled a huge stone up the mountain, only to find that the stone rolls back down the mountain; Sisyphus again rolls the stone up the mountain; then down it comes; and so on, and so on, and so on. Indeed this circular manner of problem followed by so-called-solution, followed by reemergence of the problem, and again and again is sadly the way of healthcare IT in 2016. Sad, for sure.
Bottom
line is that with the recent publicity that the third leading cause of death is
medical error (a claim that most well-respected authorities feel is without
solid basis) there will be evermore scrutiny of the different parties involved.
The solutions (user-friendly programs, easy interfaces, easy navigation,
national based CPOE and interoperability designed databases, etc.) have been
elucidated in previous blogs.
