Electronic Health Records


Will EHRs improve patient safety?

By [email protected]

Electronic health records are supposed to make care safer. This is one of the main arguments in favor or the government’s programs to encourage doctors to adopt systems.

The thinking is that by having a patient’s entire medical history in front of them physicians can make smarter treatment decisions. This can benefit patients in a number of ways, including minimizing their exposure to radiation from unnecessary medical images and ensuring that preventive treatments are delivered on time.

But not everyone is sold on the ability of EHRs to support patient safety. Some groups have even expressed concern that the technology may increase errors that put patients at risk.

The American Health Lawyers Association is one group that is taking a dubious view of the effect of EHRs on patient safety. The group recently announced that it is launching an initiative to analyze all the different ways health IT tools can increase a practice’s malpractice risk.

Some lawmakers aren’t sold either. Representative Renee Ellmers (R – NC) recently sent a letter to Kathleen Sebelius, secretary of the Department of Health and Human Services, inquiring whether any federal agency currently has responsibility for ensuring the safety of health IT tools.

The letter was sent in regards to a 2011 report from the Institute of Medicine which called for the creation of such an agency. The report says that when implemented properly, health IT tools can substantially boost care quality, improve doctor-patient communication and increase safety. However, the operative phrase there is “when implemented properly.” The paper goes on to say that improper implementation can create whole new sets of safety hazards, making an already complex healthcare system hopelessly snarled.

So how should physicians interpret these warnings? The vast majority of health IT players seem to be awfully sure the technology will lead to improvements in care quality. Do these contrarian views simply represent an overly cautious approach to health IT, or is there actually something to these types of warnings?

The answer to this question, unfortunately, is far from settled at the moment. Some studies have shown that EHRs can be a major driver in improving quality and safety, while others have indicated that sloppy implementation can put patients at risk to a greater degree than before the practice put in place a health IT system. What the evidence does seem to suggest, however, is that it’s all in how you use it.

Sure, practices that rush planning and implementation and give physicians insufficient training are likely to experience problems. In this type of setting an EHR system is likely to only get in the way of proper care, causing physicians to miss things they otherwise would have noticed, thereby hindering patient safety.

However, practices that take the time to plan and train are likely to have very different experiences. The planning phase should not only involve looking at the technical elements of implementation. Physicians should get involved in the setup process and provide input on areas where health IT might help or hurt patient safety. Practices should develop an outline specifically detailing how they will leverage EHRs as a force for good.

When physicians pay special attention to the impact of EHRs on patient safety there is little chance of the technology making a practice less safe. And by constantly looking for opportunities to improve quality through technology use doctors may start to make significant progress.

Implementing an EHR system may not be the silver bullet to quality improvement that some proponents wish it was, but practices that take care when adopting the technology are likely to see at least marginal improvements.

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