Doctors and other healthcare providers are increasingly converting their paper-based medical records to electronically stored medical record systems. Proponents of electronic medical records systems have long promised a better, safer, and more efficient method of storing medical information on a patient. However, as a new study reveals, there are some unintended consequences to electronic medical record systems. These unintended consequences can turn a seemingly small medical mistake into full blown medical malpractice.
Over two decades ago, the Institute of Medicine began pushing the medical community to convert their paper medical records to electronic medical records. The push for medical providers to embrace electronic medical records was well-intentioned. They promised providers an improved system for doctors in which a patient's medical history would be stored in one, simple, easy to access place. This would allow a doctor from any part of the world to quickly view a patient's full history without relying on the patient's recollection or waiting weeks if not months for medical records to be transferred over.
Some twenty years later, the Pennsylvania Patient Safety Authority conducted a study on the relationship between electronic medical records and patient safety. The Authority studied over 3,099 reports from various hospitals across the state detailing 3,946 medical mistakes, 2,700 of which involved near misses and 15 involved actual patient harm. The medical errors studied spanned from 2004 to 2012. Interestingly, the study found no significant change in the rate of medical mistakes from paper-based medical record systems to electronic medical records systems, with one exception: medical errors made using electronic medical records were typically amplified as they spread to other medical providers--other medical providers who relied upon the mistaken information. Thus, because electronic medical records systems are increasingly interconnected, the medical errors by one provider are often automatically transferred or propagated to subsequent medical providers--something that seldom occurred with the old paper-based medical record system.
The primary mistakes found in electronic medical records occurred because of data entry errors, rather than glitches in the electronic system. These data entry mistakes are the same types of mistakes that were made in paper-based systems. Thu, the current electronic systems are no safer than the humans who use them. The most common data entry errors involved medication errors, a common form of medical malpractice. Half of these medication errors were for the wrong medication. Similar results were found with the old paper based system, except the paper based system did not automatically distribute the error to other medical providers.
Other electronic medical record problems involved hospitals that used a combination of paper-based systems and electronic systems. In those hospitals, certain medical information may have been inputted in one form but not the other--making one incorrect. Thus, if a medical provider writes a patient is allergic to a particular medicine in the paper chart but does not enter that in the electronic chart, a subsequent medical provider who simply reads the electronic chart could write an order for a medication that is contraindicated resulting in a serious, if not deadly, medical error.
Although there are many benefits to electronically stored medical record systems, there are some serious unintended consequences that must be corrected. One way to reduce these dangers is for hospitals to fully commit to electronic records rather than continue attempting to use both. Another safety measure is for the electronic medical record programmers to provider greater safeguards designed to catch common data entry errors. These safer electronic medical record systems would alert the medical provider to certain common mistakes before the mistake harms a patient.
Mid City News, EHRs may Turn Small Errors Into Big Ones, December 16, 2012.