Working in a physician office for over 12 years, I heard a lot of patients express concerns about electronic health records. Many patients wanted to know if their data was secure, and what would happen if the computer system crashed. Patient safety concerns are further escalated in a hospital setting where life and death decisions are made every day.
Of course, providers and office staff also have significant concerns about EHR systems, and rightly so. Even after several years of implementing and optimizing these systems, there are many challenges to overcome, including patient safety risks. EHR-related issues were ranked number one on the ECRI Institute’s list of the Top 10 Patient Safety Concerns for Healthcare Organizations in 2015, 2016 and 2017, and remained in the top five for 2018.
Here are a few of the common challenges related to EHR systems that can impact patient safety:
- Patient identification issues.
- Incorrect or missing data in the EHR system.
- Inadequate test result reporting and follow up.
- Alarm fatigue from staff clicking through too many screens or alerts.
- Disconnect between EHR system configuration and office workflows.
- Insufficient training for providers and office staff.
While all of these issues can and do occur, it has been my experience that EHRs have proven to be safer and more efficient than paper charts. There have also been studies to show that, as a whole, EHR systems have not resulted in adverse consequences for patients.
Harvard researchers found that EHR systems did not significantly impact the number of reported patient safety events or mortality rates in 17 hospitals. The study included hospitals with both comprehensive and basic EHR systems, organizations with brand new EHRs, and those that had switched from one EHR vendor to another. After looking at 30-day mortality rates, 30-day readmission rates, and the AHRQ’s PSI-90 patient safety composite score as indicators of quality, the researchers found no substantial changes in any of the major measures across the study population.
Positive Benefits of EHR Systems
Despite the many challenges that come with EHR systems, there are also many benefits to providers, office staff, and patients. Sometimes it is helpful to remind ourselves of these benefits and how far we have come in the last ten years.
- Access to Patient Data from Anywhere. One of the main benefits of an EHR system is that providers can access a patient’s chart from anywhere, at any time. On-call providers working after hours can log into the EHR system to view a patient’s history, current medications, and recent test results. All of this can improve patient safety by providing the necessary information to make an accurate diagnosis and treatment recommendations.
- Enhances Data Sharing Among Providers. EHR systems also allow for more seamless sharing of patient data between healthcare providers so that everyone has access to the same information in real time. This is nearly impossible in offices that still use paper charts, fax, or email communication.
- Reduces Repeat Testing and Procedures. Maintaining all of a patient’s data in a single place can help to reduce the ordering of unnecessary tests and procedures. This is especially true when data is shared between the primary care provider and a hospital system or emergency department.
- Prevents Medical Errors. Another benefit of having all of the patient’s information in a single location is that it can prevent medical errors. For example, some EHR systems will help flag potential conflicts when physicians are ordering a medication for a patient that may interfere with another part of his or her regimen.
- Less Time Spent on Paperwork. When implemented correctly, an EHR can also make day to day work activities more efficient. The average physician spends about eight hours per week on paperwork. An EHR system can reduce that number to less than two hours per week, leaving physicians with additional time to focus on patient care.
- Fewer Malpractice Claims. If malpractice claims are a measure of patient safety, then EHR systems provide a distinct advantage. A study from Harvard Medical School found that the rate of malpractice claims for physicians using an EHR system was one-sixth of the rate of physicians who did not use an EHR system.
While there continues to be significant debate about the impact of EHR systems on patient safety, there is a lot of evidence to show the effectiveness of EHR systems. With 62 percent of physicians reporting a positive perception of their EHR system, one could argue that at least we are headed in the right direction. Many times, it is not the EHR system itself, but the implementation of the system that causes headaches and challenges for physicians and office staff.
No matter where you come down in the patient safety debate, it seems that EHR systems are here for the long haul. By investing in EHR optimization and continually seeking to improve your office workflows, you can have a positive impact on patient safety and quality of care.