Electronic Health Records

Hybrid EHR-paper workflows contribute to medical errors

Healthcare organizations or providers using a mixture of paper and electronic records for clinical documentation are setting themselves up for potentially dangerous medical errors, according to research published by the Pennsylvania Patient Safety Authority.

“Use of a hybrid workflow can lead to miscommunication among caregivers when orders and administration information differ between paper and electronic systems,” writes Erin Sparnon, MEng, Senior Patient Safety Analyst at the Authority. “This miscommunication can lead to medication errors like dose omissions and extra doses, which can cause serious harm to patients.”

Of the 3,099 cases of EHR-related incident reports available to the independent state agency, a total of 89 were the result of hybrid workflows. Most of those errors were reported (77 incidents; 91%) comprise errors not leading to adverse outcomes with the remainder leading to unsafe conditions (7; 8%) or temporary harm (1; 1%). The most common error reported dealt with medication with nearly three-quarters (63; 74%) classified as “medication error.” Of those incidents, the greatest number was the result of wrong medication being given (22%).

In searching for the cause of these hybrid EHR-paper scenarios, the research cites a number of factors, not all of them the result of healthcare organizations being in the process of transitioning from paper to electronic as promoted by the EHR Incentive Programs (i.e., meaningful use):

Hybrid workflows may arise by design as a necessary transitional state between all-paper and all-electronic workflows or as an unintended workaround. Although meaningful use incentives have increased EHR adoption projects in the last several years, these projects do not always lead smoothly to fully electronic workflows. Funding gaps, competing priorities, and a lack of industry education have left many facilities in extended or indefinite transitional periods in which both paper and electronic systems are maintained. Even in a nominally all-electronic workflow, hybrid workflows can arise as a workaround if clinicians supplement use of an electronic system with handwritten notes as documentation aids.

Although best practice maintains that a complete transition to electronic records is the ideal solution to the hybrid problem, the Pennsylvania Patient Safety Authority is advising those finding themselves using hybrid EHR-paper workflows to take two steps toward mitigating risk.

“In order to meet the logistical and legal challenges of hybrid workflows, facilities need to create and maintain documentation of where different pieces of their medical records are stored,” writes Sparnon. “In designing this documentation process, facilities may wish to conduct a comprehensive workflow analysis on the process of accessing all the data required to fulfill release of information requests.”

Read the complete report here. The latest issue is available here.

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