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EHR Use Does Not Preclude Provider Data Communication Errors

Data misrepresentation among physicians could pose a threat to patient safety even where EHR use is commonplace.

EHR Technology.

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By Kate Monica

- Well-established EHR adoption does not eliminate the potential for inaccurate provider-to-provider clinical data communication.

A recent study by Artis et al. of laboratory data communication among intensive care providers at the Oregon hospital found misrepresentation to be commonplace.

“At our institution, despite well-established EHR use and structured interprofessional ICU rounds, we discovered that laboratory misrepresentation was a pervasive phenomenon. It occurred on almost every patient and multiple times within the same presentation, involving nearly 40% of the laboratories studied,” they write in a recent Critical Care Medicine article.

The study focused on the accuracy of lab data communication during the Oregon Health and Science University Intensive Care Unit (ICU) daily rounds where Epic EHR data was available.

To minimize issues in this area, Artis et al. conducted a study exploring how many of these errors are made and the frequency at which rounding teams are addressing and remedying these errors.

According to authors, research shows that patients in the ICU generate a massive amount of data —1,300 new data points per ICU patient per day — clinicians must accurately collect, interpret, and analyze in order to most efficiently and successfully make smart decisions in patient care. While data collection is a necessary component of delivering high quality patient care, such a muddled flood of information can often hinder instead of help providers.

In fact, previous studies show errors in data collecting and processing can have grave implications ranging from misdiagnosis to patient harm.

With optimizing patient care as the ultimate aim, researchers tackled this issue for a variety of reasons.

For one, they found a trend of diagnostic errors in the ICU despite frequent rounds in place designed to avoid such errors. The ICU rounds created to spot and stop diagnostic errors seemed less effective than physicians had hoped.

Secondly, previous studies point to a disconcerting amount of data communication failures during patient handoffs in part due to a lack of standardized data reporting practices in ICU rounds.

Most notably, one study showed 28 percent of ICU deaths demonstrated at least one overlooked, inaccurate, or delayed diagnosis. Six percent of these mishandled diagnoses were potentially fatal. 

Despite the up-to-date technology in place including well-integrated Epic EHR, clinician laboratory data retrieval and communication during ICU rounds at an institution was inconsistent, reflecting omissions and inaccuracies the rounding team did not notice.

Through first-hand observation of verbalized laboratory data during daily ICU rounds compared side-by-side with aggregated EHR data, researchers noted the accuracy of communicated patient data.

Researchers found 4,945 audited laboratory results in 301 observed patient presentations. Presenters used a paper prerounding tool for 94.3 percent of presentations, but these tools contained only 78 percent of electronic health record laboratory data.

Of the observed patient presentations, 96 percent included at least one laboratory misrepresentation, and only 7.8 percent of these were ever detected by rounding teams. These errors were mostly omissions.

EHR technology was integral to conducting this study and evaluating physician data collection and data communication accuracy during ICU rounds. The technology allowed for streamlined, efficient comparisons leading researchers to confirm the hypothesis that data communication during ICU rounds are especially susceptible to errors.

Overall, the study found trainees only accurately reported 61.1 percent of data with no noticeable difference between data collection periods. Laboratory data misrepresentation was ultimately deemed a pervasive, constant issue — despite the presence of an up-to-date, fully functional EHR technology available.

Researchers noted the study highlighted the shortcomings and limitations of electronically generated prerounding tools.

Artis et. al. recommended designing a single, comprehensive, unit-wide prerounding template to alleviate some of the issues regarding standardization and sidestep errors caused by a lack of uniformity in reporting tools. Additionally, researchers maintained an electronic prerounding tool with the capabilities to automatically refresh and reflect new data in real-time would cut down on errors made through using outdated information.

The study found many vulnerable spots in ICU rounds raising red flags about the ability of providers to remain accurate in data reporting and communication under stressful conditions particularly when dealing with a large number of patients.

“Data fidelity was worse when census exceeded 14 patients or after the 14th patient presented, further supporting 14 patients as a critical census threshold beyond which the quality of ICU care declines,” noted the written report.

Addressing these issues is critical to optimizing EHR use in hospitals to improve patient care and avoid potentially life-threatening errors in diagnosis.

 

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