Accumulating evidence suggests that electronic medical records (EMR) and electronic medication administration records (eMAR) are of benefit in hospitals and private family practices. And a 2008 systematic review of 67 studies shows that electronic prescription entry also reduces serious medication errors.
Hospital bar codes reduce drug errors. According to a report by Poon and colleagues in the May 6 New England Journal of Medicine, bar code technology combined with an eMAR system substantially reduced medication errors in hospitalized patients. Researchers compared medication administration by staff nurses on hospital units before and after the system was introduced.
In the study hospital, after pharmacy approval, medication orders appear electronically on a patient's chart, and nurses receive electronic alerts if the medication is late. Before giving a drug, nurses scan a bar code on the patient's wristband and then on the medication. A warning is given if the two don't match or if the time of dosing is incorrect. The researchers evaluated 6,723 medication administrations before bar code eMAR implementation and 7,318 after the system was adopted.
The bar code eMAR technology reduced the overall rate of nontiming errors (those not related to the timing of dose administration) by 41% and adverse drug events by 51%. The rate of wrong-medication errors fell by 57%; errors related to dose fell by 42%. The rate of timing errors (patients receiving medication at least an hour too early or late) fell by 27%.
Because the study site administers 5.9 million doses of medication each year, the authors estimate that the electronic system could prevent 95,000 adverse drug events at the point of administration annually, as well as 270,000 timing errors and 50,000 adverse events related to transcription errors.
Bar code eMAR systems give "nurses a second look that they would never have without the technology," says Judy Hayes, a study coauthor and vice president of nursing at Faulkner Hospital in Boston. When bar code eMAR systems were first introduced, nurses complained that scanners were giving incorrect results, but a closer look showed that the medications and doses were indeed incorrect. Once nurses realized that the system caught errors, "the news spread like wildfire," says Hayes, and "nurses accepted it as a tool that was good for them and their patients."
Electronic technology at family medical offices. Reporting in the May issue of Family Medicine, Elder and colleagues examined the use of EMR systems in managing test results at eight family practice clinics in Ohio. At each office, 25 patient charts were reviewed to see whether laboratory and imaging test results were handled correctly, meaning that results were in the correct place in the chart, had a clinician's signature and had been interpreted, patients had been notified, and abnormal results had been followed up.
One of the study variables was the presence or absence of an EMR system. In the offices with EMR systems, all results had a clinician's signature, compared with 86% in offices with paper records. Results had been interpreted more often in offices with EMR (73%) than in those with paper records (64%), and more patients had been notified of results: 80% versus 66%, respectively. In offices with an EMR system, abnormal test results were followed up 64% of the time, compared with 40% of the time in offices with paper records.
"Systems designed expressly for the purpose of results management have been reported to improve satisfaction for both patients and providers," the authors write, but most "clinicians use 'off the shelf' products"; as a result, test results management is lacking "because such features need to be customized and supported." They believe that clinicians and EMR manufacturers "need to work together to improve these systems."
Medication error reduction in hospitals. A systematic review by Eslami and colleagues of 67 studies (reported in the June 2008 International Journal of Medical Informatics) found that electronic prescriptions, or computerized physician order entry (CPOE), reduced medication errors (although its effect on [adverse drug events] "did not merit enough attention"). CPOE also solved the problem of pharmacists having to decipher poor handwriting and sped the delivery of medications to hospital units, although it increased the time physicians took to write prescriptions. The majority of users believed CPOE improves drug management and quality of care.
Most nurses are familiar with EMR systems, but bar code eMAR systems aren't universal, says Toni Hebda, a nursing professor at Chatham University in Pittsburgh, Pennsylvania. Nursing students are being trained in newer processes like bar coding. Acute care facilities are rapidly moving toward electronic systems, and "there are fewer and fewer settings where nurses can use paper documentation," says Hebda, who adds that, when used well, health information technology "can streamline care, provide decision support, and track health and disease management of individuals and groups over time."—Carol Potera