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The Overdose – When EHRs Go Wrong

Posted on March 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re getting more and more stories coming out about the impact for bad that an EHR can have in medicine. Most of them have been anecdotal stories like The Old Man and the Doctor Fable and Please Choose One. However, today I came across one that talked about an overdose due to an error in the use of EHR. Here’s a summary of the discovery:

Levitt’s supervising nurse was stumped, too, so they summoned the chief resident in pediatrics, who was on call that night. When the physician arrived in the room, he spoke to and examined the patient, who was anxious, mildly confused, and still complaining of being “numb all over.”

At first, he was perplexed. But then he noticed something that stopped him cold. Six hours earlier, Levitt had given the patient not one Septra pill—a tried-and-true antibiotic used principally for urinary and skin infections — but 38½ of them.

Levitt recalls that moment as the worst of her life. “Wait, look at this Septra dose,” the resident said to her. “This is a huge dose. Oh my God, did you give this dose?”

“Oh my God,” she said. “I did.”

If you read the whole article linked above, you’ll discover that the issue happened when entering the dosage for a drug into the Epic EHR system at UCSF. I’m not here to point fingers since every case is unique and you could argue forever about whether it’s the software’s responsibility to do something or whether the person using the software is responsible for understanding how the software works. I think that’s a discussion that goes nowhere since the right answer is that both can do better.

These types of stories are heartbreaking. They even cause some to question whether we should be going electronic at all. I’m reminded of a time I was considering working at a company that did expert witness testimony for cars. One of their hypothesis was that the computers that are now found in cars will usually save people’s lives. However, in a few cases they’re going to do something wrong and someone is going to lose their life. I think that’s where we’re at with EHR software. It’s not perfect and maybe never will be, but does it save more lives than it kills?

That’s a tough question that some people don’t want to face, but we’re going to face it whether we acknowledge the question or not. Personally, I think the answer to that question is that we do save more lives with an EHR than we damage. In the case above, there were still a lot of humans involved that could have verified and corrected the mistake with the EHR. They didn’t, but they could have done so and likely do with hundreds of other mistakes that occur every day. This human touch is a great counterbalance to the world of technology.

If we expanded the discussion beyond lost lives, it would be a much more challenging and complex discussion to know if EHR makes an organization more or less productive. I believe in the short term, that discussion is up for debate. However, in the long term I’m long on the benefits of EHR when it comes to productivity.

None of this should excuse us from the opportunity to learn important lessons from the story above. We need to be careful about over reliance on data in the EHR (similar to over reliance on a paper chart). We need to make our EHR smarter so that they can warn us of potential problems like the ones above. We need EHR vendors to not let known EHR problems remain unfixed. We need a solid testing plan to avoid as many of these situations as possible from ever happening in the first place.

There’s a lot of work to do still to improve EHR. This story is a tragic one which should remind us all of the important work we’re doing and why we need to work really hard to improve it now.

Sometimes We Forget the Consequences of Doing Nothing

Posted on March 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare IT publications like to hop all over a story that talks about the negative side effects of EHR or some other technology in healthcare. The train wreck is something that people love to read about and so publications love to lather up the story and report all of the problems and challenges a hospital faces when going electronic.

This isn’t an awful thing. We should be aware of the challenges related to implementing technology in healthcare. Hopefully that extra exposure will help us to improve the technology so it’s no longer an issue. However, we have to be careful to not skew our view of technology based on what’s being reported by the healthcare IT publications we read.

The problem with basing our assessment of something on the media is that it’s not exciting for them to report on benefits that have become part of the status quo. No one’s going to read the article that says lives are saved because a doctor can read the chart since it was typed as opposed to illegibly written on paper. Being able to actually read the chart has become so common place, that we’ve started to take it for granted. Medical students today might never have the opportunity to read paper medical hieroglyphics. That’s a fantastic thing, but it doesn’t make for a good story.

It’s almost like we ignore the benefits once they become part of the fabric of how we practice medicine. Plus, we don’t even think about the negative consequences we’ve avoided. As someone told me recently, “No one gets paid for the crisis they averted.”

As part of our analysis, we have to remember to compare the status quo to the alternative and not to the ideal. That’s not to say that we don’t continue to strive for the ideal. We absolutely should push towards it. However, it does mean that we keep a proper perspective on reality and don’t forget the past.

Getting More Out of the EHR Than What You Put In

Posted on January 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I first met with Stoltenberg Consulting a few years back at CHIME, they said something really interesting that I’m still thinking about today. In fact, I might be thinking about this more today than I was doing before.

Per my notes (so I won’t make it a direct quote), they commented that doctors were putting a lot into the EHR, but they don’t feel like they’re getting a lot out of the EHR.

It’s a powerful idea that is really important for any hospital executive to understand.

I recently wrote about the choice between the Best-of-Breed EHR and the All-In-One EHR approaches on EMR and HIPAA. Here’s the money section:

The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Choice of EHR is only one of the main reasons why doctors likely feel that they’re getting less out of the EHR than they’re putting into it. Certainly reimbursement requirements and meaningful use should still take a lot of the blame as well. Regardless of how we got here, it’s a very precarious position when the doctors feel like they’re getting less out of the EHR than they are putting into it.

There is a solution to this problem. First, you must work to maximize the physician workflow. Sometimes this means involving the nursing staff more. Sometimes this involves a scribe. Other times it requires a change to your EHR. Other times it means building out high quality templates that make the doctor more efficient.

Second, we must all focus on more ways doctors can get more value out of their EHR. The buzzword analytics has potential, but has been a little too much buzz word and not enough practical improvement for the doctor and patient. We need more advanced tools that leverage all the data a doctor’s putting in the EHR. Clinical Decision Support, Drug to Drug and Drug to Allergy checking are just the first steps. We can do so much more, but unfortunately we’ve been too distracted by government regulation to deal with them. Plus, let’s not kid around. These aren’t easy problems to solve. They take time and effort. Plus, we need a better way for doctors and hospitals to be able to diffuse their discoveries across the entire healthcare community. Sharing these discoveries is just too hard and too slow right now.
EHR Scale
At the end of the day, it’s a simple scale. On the one side you have the time and effort a doctor puts into the EHR. On the other side is the value the doctor gets from the EHR. You can solve this by making the doctor’s EHR work more efficient or by finding more ways the EHR can provide value to the doctor. Much easier said than done. However, if this stays out of balance too long, you can count on a big EHR backlash from doctors.

Only 40% of Hospital CIO’s measure ROI on Their EMR Implementations

Posted on August 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, I stumbled upon this fascinating tweet about hospital EMR ROI. It’s from @dbtech_Ras:

Unfortunately the tweet doesn’t contain the source of their information, but the idea of EMR ROI is a very interesting and important topic. Should a hospital CIO be tracking the ROI of their EMR implementation? Are most hospital CIO’s tracking EMR ROI?

I would imagine many hospital CIOs aren’t tracking EMR ROI, because they see EMR as a necessary requirement of being a hospital today. Do they track the ROI of cleaning supplies? No. They just realize they need them and they try to manage the cost of the supplies as best they can. I think many are treating EMR in this same manner. They see EMR as a necessity regardless of ROI.

The interesting thing is that there are actually a lot of ways to measure an ROI for EMR software. None of them are perfect and they certainly leave out all the intangibles and long term benefits of EMR. For example, how do you measure an ROI on legibility of charts? That’s tough. It’s also hard to predict how having your charts electronic will enable you to be a better hospital 5-10 years from now. Not to mention if reimbursement eventually will require an EMR. Things like this will happen I’m sure.

With those disclaimers, you still can calculate an ROI. The low hanging fruit is the EHR incentive money and the future EHR penalties for not having an EHR. These add up to really large numbers for hospitals. You can also look at productivity before and after the EHR. Of course, depending on how you implement the EMR, this could actually be a cost of EHR as opposed to a benefit. Either way it should be calculated in the ROI. There are many more.

From what I’ve seen everyone sees the future of physician documentation is going to be in an EMR. Just because the move to EMR is inevitable doesn’t mean you shouldn’t still keep focused on the ROI you can receive from it.

Is your hospital tracking your EHR ROI?