The benefits of electronic health records (EHRs) have been widely touted, fueling the digitization of patient medical records in the United States. Advances in computer technology coupled with government subsidies to defray the cost of transitioning from paper to digital records added momentum over the last decade.
The belief has been that consolidating patient data in interactive EHRs would yield higher quality care, lower costs, and an overall healthier population while encouraging patients to be more involved in their health care. However, a recent joint report from Kaiser Health News and Fortune magazine, Death by a Thousand Clicks:Where Electronic Health Records Went Wrong, details serious consequences that can befall patients with the use of these systems, particularly in the absence of coordinated regulation.
The authors describe systemic failures in transmission of physician orders, mix-ups in patient profiles that could lead to potentially catas-trophic medication errors, and issues with “interface,” where online systems used by pharmacies and laboratories, for example, might fail to communicate with each other.
The American Nursing Informatics Association, the American Nurses Association, and National Nurses United have all called for improved standards and better monitoring of EHR performance, including reporting systems for patient safety events associated with EHR use. Their positions echo a 2012 Institute of Medicine report (Health IT and Patient Safety: Building Safer Systems for Better Care) that declared the state of safety and health information technology as “not acceptable” and recommended a safety overhaul of EHRs, including mandatory reporting of related deaths, injuries, and unsafe conditions.
Despite such calls for action, only scattered guidelines have emerged from government agencies, such as the Office of the National Coordinator for Health Information Technology, which issued nine “SAFER Guides” to help health care organizations optimize safe use of health information technology (www.healthit.gov/topic/safety/safer-guides), and the Agency for Healthcare Research and Quality, which issued a “Patient Safety Primer” to guide information technology use (https://psnet.ahrq.gov/primer/electronic-health-records). But there is still no coordinated regulation or oversight of these systems and no central database for reports of error and patient harm related to EHR use. For more, see https://khn.org/news/death-by-a-thousand-clicks.—Gail M. Pfeifer, MA, RN