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EHR Data Management Tops ECRI List of Patient Safety Threats

A recent ECRI report lists EHR data management and improper use of clinical decision support tools as two of the biggest potential threats to patient safety.

Patient Safety.

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- ECRI Institute recently published their 2017 Top 10 Patient Concerns for Healthcare Organizations using findings acquired through the institute’s Patient Safety Organization (PSO) event data, input from healthcare provider organizations, and recommendations from experts.

Atop list of top patient safety concerns for 2017 is EHR data management as the leading concern based on its potential to cause patient harm directly.

“Most organizations already know what their high-frequency, high-severity challenges are,” the report authors stated. “Rather, this list identifies concerns that might be high priorities for other reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention.”

While EHR technology has given providers access to a wealth of patient information useful in delivering appropriate patient care, such a large amount of data can also overwhelm providers trying to manage and utilize the information in a meaningful way.

"The object is still for people to have the information that they need to make the best clinical decision," said Lorraine B. Possanza, who serves as Senior Patient Safety, Risk, and Quality Analyst and Health IT Patient Safety Liaison at ECRI Institute. "Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible."

Educating providers on how best to utilize EHR technology is a necessary step to optimizing the benefits and minimizing the risks inherent to managing and exchanging patient health data.

Patient empowerment around understanding how to access information could also be useful in improving patient safety.

“Healthcare organizations must approach health IT safety holistically. One key step is integrating health information management professionals, IT professionals, and clinical engineers into patient safety, quality, and risk management programs,” stated the report. “Other strategies include ensuring that users understand the system’s capabilities and potential problems, encouraging users to report concerns and investigating those concerns, engaging patients in information management, and harnessing the power of EHRs to enhance patient safety.”

Implementation and use of clinical decision support (CDS) clocked in at number three on the list of safety concerns based on the potential for missed opportunities to engage CDS tools so that the proper information is available at the appropriate time within clinical workflows.

“On an ongoing basis, organizations should monitor the effectiveness and appropriateness of CDS alerts, evaluate the impact on workflow, and review staff response to alerts,” stated authors in the report. “The tool should be redesigned as necessary.”

Patient identification was also listed as a source of concern for healthcare organizations.

The lack of a nationwide patient identification system has been repeatedly flagged as a problem area in the healthcare industry as health data exchange between providers becomes more and more common.

Ensuring a patient’s EHR can follow her wherever she goes is imperative to streamlining transitions in care from one provider to the next, but potential issues with patient identification can cause more harm than good when administering care.

“Redundant processes for patient identification can increase the likelihood of preventing patient mix-ups. Elements such as electronic displays and patient identification bands may be standardized,” stated the report. “When used as intended, bar-code systems and other technologies can also support safe patient identification.”

Other sources for concern listed in the report include unrecognized patient deterioration, test result reporting and follow up, antimicrobial stewardship, opioid administration and monitoring in acute care, behavioral health issues in non-behavioral-health settings, management of new oral anticoagulants, and inadequate organization systems or processes to improve patient safety. 

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