Reporting EHR Medical Errors

Tom Hubbard brings up some interesting points about EHR medical errors. He suggests that nobody routinely reports EHR medical errors. I would ask if anyone reports EHR medical errors. Where would they report the EHR medical errors? There’s no real governing body for EHR medical errors. Sure, we could make up some places.

A number of years ago I remember some organization stood itself up to be a place where doctors could report errors they found in an EHR software. Of course, this brings up an interesting question. When is the error a user error and when is the error an EHR system error? That gets pretty complex and I’m sure some expert witnesses are going to make a killing testifying for and against the EHR companies. Unfortunately (or fortunately depending on how you look at it), I’m not interested in that kind of work. I prefer building and supporting cool things as opposed to tearing things down.

What do you think of EHR medical errors? Who should have oversight of these problems? Where and how should something be reported? Is this much ado about nothing? Or should we be making a bigger deal out of this since it’s currently just being swept under the rug and ignored?

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • There absolutely NEEDS to be a place to report EHR medical errors. We have had a repeated bug that loses the notification of lab results at random points during the day. The results are still the patients chart but the notification to the doc that the results have returned goes missing. We have been complaining to the company for over a month. This happened with a PT-INR 3 weeks ago. The problem with errors like that is since we didn’t create them, we cant RE-create them for the tech at the company, so their first line of defense is always “user error”.

    This has now happened a couple of times in different ways. Each time the company says it’s our fault at first and no one else has complained about that, then when we badger them repeatedly, and have the staff be on the lookout for an example, then stop everything when the error occurs and get a tech from the company to look at it online(effectively removing that employee and computer from action until the service is over)…eventually they conclude it is a bug in the program that they will fix at the next update(which incidentally usually brings a fresh round of bugs).

    When the abnormal INR results went missing, I called our malpractice insurer asking how we defend ourselves against this. The answer? “You and your lab company are both baking this all this up with a paper system, right?” So all this cash outlay, retooling, retraining, regulation to go paperless and my only defensible stance is to back it all up with paper?

    We’ve been on an electronic EHR of one kind or another since 1992. We are not neophytes. We are now with a reputable company that’s been around for years. The errors are increasing with the complexity of what’s being asked from the system. Two offices in my town have stopped this futile fight and gone back to … paper charts.

    However, were there a regulatory body tasked with taking these complaints, they would be overwhelmed with the frustration of 10’s of thousands of providers. We are being held legally accountable for the accuracy of a tool over which we have no real control. It’s not like my stethoscope fell apart. I can see and fix that. the health care system, AND the people who rely on it should be very afraid. IS anyone inventing an EHR that is so simple that the doctor who uses it can understand how to trouble shoot it? If not, we need to hold the EHR makers responsible.

  • Dr. Annis makes an excellent point – EHRs are a tool. The vendor provides a framework and the organization builds and implements it. Any error in an EHR system can (and will) have multiple causes, from bugs in the actual code to clinical errors in the build to failures of interfaces to other clinical systems. Most of the errors I’ve seen are not software errors, they are build errors or workflow errors. Too many organizations approach EHR builds as an IT project, and by the time a clinician sees the final product it’s almost unrecognizable. The best EHR in the world is only as good as the organization implements it. I think the Globe missed that point – each vendor’s software has strengths and weaknesses, but it’s up to the organization to be aware of them. Organizations should gather data about EMR errors just like they gather data about other patient safety incidents. The errors may be vendor-related or they may be implementation-related, but in either case they are SYSTEMIC. Even the best medical provider can’t protect themselves from a system that doesn’t work.

  • One of the big disappointments following the FDASIA report is the reduction of their “Health IT Safety Center” idea to lowest common denominator. Unlike the kind of rigorous review that the airline industry famously undertakes, this safety center will be some kind of optional exchange of ideas. I complain about that here:

    http://bit.ly/1o5DOP5

  • Mr. Hubbard did an excellent job of discerning the two types of EHR
    “medical errors.” One is the standard “medical error” that existed even in in the hard copy, paper chart era. That medical error was directly correlated with the physician and/or nurse entering wrong data and/or the physician/nurse placing improper orders. Orders being contexted as medications, procedural or care instructions.

    Entering mistaken data was corrected by drawing a simple single line through the mistaken documentation, initialing the line and placing the corrected documentation above the line.

    Improper medication orders were surveyed for by the attending RNs, respective therapists, pharmacy and related hospital staff. Speaking to the possible EHR “medical errors” Now with the EHR medication contraindication alerts, best practice alerts and diagnosis/problem list/order paralleling the IT system will present appropriate Warnings to the screen of the patient’s chart. The use of the scanning IT is also a protective feature within the EHR process.

    The EHR “medical error” alert and notification feature is only as robust and concise as the data being entered into the EHR by the various clinicians. When a clinician discovers an IT malfunction there is always an in-house IT department that can be notified of the problem/s. This IT department can then discern the need of scaling the IT malfunction.

    As for the clinical data entry, that is still the responsibility of the human healthcare provider, nurse and associated staff. The bottom line is that the EHR is a documentation tool and the respective treatment team members are ultimately responsible for entering the correct diagnosis on the Problem List, flow sheet documentation that prompt the rounding physician’s ongoing order decisions. The human treatment team is ultimately responsible for any and all care associated with the patient at hand. The EHR works for the treatment team and the patient, not the other way around.

  • Dr. Annis,
    It seems like what you describe is just holding EHR vendors accountable. There’s no organization that can do that right now. I’m not sure any of the organizations out there could do a good job of it right now either.

Click here to post a comment
   

Categories