One of the most important drivers to implement EHRs is to make care safer. Early trials showed impressive reduction in adverse drug events with CPOE that uses decision support to identify problems with entered orders during the ordering session. There was a 55% reduction in serious adverse drug events with CPOE compared to orders written without CPOE. Other studies using cleverly designed screens to order laboratory test reduced orders for duplicate tests (as defined by the ordering clinician, specific to the patient and circumstances of that order) were reduced by 13%. CPOE screens that guided clinicians prescribe for patients with renal insufficiency resulted in improved dose and frequency choices.
Health IT can help patient safety in many other ways, beyond use of an EHR. Bar code medication administration can identify mismatches in the ‘5 rights’ of medication use, electronic sign-out systems make baton-passing between clinicians changing shifts faster and safer, and there is promising evidence that mobile phone messaging may be beneficial to patients with chronic illness.
Based on these studies and many more, several nations including the US have provided financial incentives for individual providers and hospitals to adopt EHRs and to use them to enter orders and in other ‘meaningful’ ways. Concentrating on the US experience, this incentive program has worked: in the space of less than 5 years there has been dramatic rise in EHR
Why then are EHRs not more popular with front-line clinicians? Because just as beneficial medications have side effects, so do EHRs. As currently used, they often take more time—precious time that should be spent listening and talking with patients; their design is confusing to many; and once an EHR is in place there is an almost irresistible temptation to ask the clinician to enter more information into the EHR. The result is pushback from providers.
The EHR user experience is no longer just the topic of academic journal articles, it is the subject of Congressional hearings. So is it back to the drawing board? Probably not, but it is certainly time to review the basics. In the 40 or more years we’ve been developing, testing, implementing and studying EHRs we’ve learned lots of lessons and forgotten some of them. And there are many more lessons to be learned and shared. With luck those who will teach us some of those lessons will include people fresh to health IT. There are glimmers of hope for how we can make care even safer and easier to deliver with EHRs. As William Gibson famously observed, “The future is already here, it just isn’t evenly distributed.”
Dr Thomas Payne MD will be speaking on ‘IT & Patient Safety: successes, promises & pitfalls to avoid’ at the upcoming Transitioning to eMedication Management Systems Conference. Book your place by August 14th and save $100!
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U.S. Senate Committee on Health, Education, Labor & Pensions. “Achieving the Promise of Health Information Technology: What Can Providers and the U.S. Department of Health and Human Services Do To Improve the Electronic Health Record User Experience?” Hearing Tuesday, June 16, 2015, 430 Dirksen Senate Office Building.