Electronic Health Records

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ECRI: Data integrity, health IT failures top patient risk list

By Jennifer Bresnick

Poor data integrity and gaps in the health IT infrastructure pose a serious risk to patient safety, says the 2014 Top 10 Patient Safety Concerns list from ECRI Institute.  Along with a lack of care coordination as patients move across the healthcare system, gaps in the way providers utilize their health IT assets, including EHRs, can leave patients at risk for serious complications or death.  After reviewing its database of patient safety events, collected since 2009, ECRI has also identified test result reporting errors, mislabeled specimens, and inadequate monitoring of patients on certain medications as additional critical issues affecting healthcare organizations in 2014.

While EHRs dropped to fourth place on the 2013 health technology hazards roundup, replaced by alarm fatigue as the most pressing concern, the integrity of patient data is still a major factor in a number of patient safety incidents.  “The integrity of data in health IT systems can be compromised from any of the following: data entry errors, missing data or delayed data delivery, inappropriate use of default values, copying and pasting older information into a new report, use of both paper and electronic systems for patient care, and patient/data association errors (i.e., patient data from a medical device is mistakenly associated with another patient’s record),” the report explains.

Copying and pasting with the EHR, also known as cloning, has cropped up as a major worry for organizations like AHIMA, even though the practice is extremely widespread among physicians eager to save a few minutes of typing and clicking.  However, the errors that result from improper workflow shortcuts can compound into duplicated or outdated information that could have a direct impact on patient care.

ECRI suggests that providers assess their clinical workflows to understand how front-line users of health IT systems operate, and conduct thorough testing in a simulated environment to ensure that systems work as expected.  Developing a comprehensive and standardized reporting procedure, so users can identify problems and make suggestions, can help to fine tune the workflow and ensure patient safety remains a top priority.

Care coordination was also flagged as a major shortcoming of healthcare organizations in 2014.  Patients who transition from the inpatient setting to aftercare often leave the hospital without their data, the report says, and may not realize that their primary care provider has not received information from other organizations.   While EHRs can help bridge these gaps by facilitating data exchange, they can also highlight problems that might be passed back and forth between providers, none of whom are sure of where the responsibility lies for a missing test result or abnormal finding.

Delays or failures to report test results to the ordering provider made up 10% of the 2420 events reviewed for the list, ECRI says.  “We’re seeing more opportunities for missed information transfer, errors in information, errors in orders,” says Linda C. Wallace, BSN, MSN, CPHRM, director of aging services risk management at ECRI Institute.  To ensure that patient data is appropriately addressed, the report recommends that providers develop a process detailing timeframes for follow-up, methods of communication between multiple providers, and reporting standards to ensure that every organization involved receives the right data at the right time.

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