Avoiding the human mistakes in electronic medical records

Even healthcare providers make mistakes. The most insidious errors in electronic medical records escape detection because they are concealed by terabytes of data and the people needed to catch them are not around

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Five years ago I was lying on a hospital bed looking at the concerned faces of my wife and a surgeon who I had met only that day. An hour earlier I was getting a CT scan, the result of which was already at my bedside. Kudos on that!

I didn’t argue, when my new acquaintance instructed the nurse to administer a bolus of morphine. Candidly… I could have told him that was a good idea a lot earlier — even without the CT.

I remember taking what seemed like a normal breath and then exhaling… and exhaling… and exhaling. Everything had gotten so slow so fast and in such a very pleasant way.

Then, as my wife recalls, I “got this look.” She said she asked me if I was all right. “You didn’t say anything — which I thought was kind of weird. Then you turned gray.”

I had apparently been given, as the doctor told my wife at the time, “too much,” a conclusion that was followed soon by an injection to counteract the first.

It wasn’t long until time began to pass normally again. My color returned. And all was as it should have been.

Hey, we all make mistakes. Even healthcare providers. The most insidious escape detection because the people needed to catch them are not around and, once committed, are concealed by terabytes of data, mistakes, for example, involving electronic medical records (EMRs).

Issues related to health IT have been on the ECRI Institute’s top 10 lists of health technology hazards for the last six years and on the top 10 list of patient safety concerns since the Institute started compiling this list in 2014. Appearing at No. 2 on this year’s list of patient safety concerns: “Data integrity: incorrect or missing data in electronic health records and other health IT systems.” 

Among the listed failures:

  • Appearance of one patient’s data in another patient’s record
  • Missing data or delayed data delivery
  • Clock synchronization errors between medical devices and systems
  • Default values being used by mistake, or fields being prepopulated with erroneous data
  • Inconsistencies in patient information when both paper and electronic records are used, and
  • Outdated information being copied and pasted into a new report.

What makes this so aggravating is the extraordinary potential of this technology, which ECRI Institute notes can support clinical decision making; enhance provider communication; provide access to patient data in a secure environment; engage patients; even reduce medical errors. “But the technology can create new safety risks if it is not designed appropriately, implemented carefully, and used thoughtfully,” the report states.

So… how to do this? A few ideas have popped up in Meddit, the medical offshoot of the social medium Reddit. Medical professionals come to this cyber lounge, according to Meddit, to” talk about the latest advances, controversies, ask questions of each other, have a laugh or share a difficult moment.”

The question posted last year by an industrial engineer about the “biggest issues with current electronic medical record solutions” spurred 61 comments. Some are insightful. Some so obvious it is hard to believe they are not in common use. Some flat out hilarious. Among them:

Get coders on the floor. “Seriously, put coders in the hospital… Make them rotate through for a month at a time. Make them work nights so they see what happens at 2 am when the patient just crashed and I've got to explain what happened in permanent, archival digital format, at 2 in the freaking morning.”

Design EMRs for doctors. “A lot of programs are not intuitive to how one would work up a patient. Ideally, I would like to see a single scrollable page for an admission or HPI (history of present illness)/physical/plan/assessment.”

Load times. “The patient's chart should open 30 seconds from log in. The idea that I have to wait sometimes over 5 minutes is obnoxious to me. Especially when I have to move all over the hospital and use different computers in every wing I have a patient... I need to have the e-chart open as fast as I could have a paper chart open.”

Color-code what’s clickable. "Use blue for clickable, grey for nonclickable (not blue and light blue… You have the ENTIRE color pallet). Use Red color coding for lab values that are outside the range."

Or don’t click. “Don't make me click a single stupid box. I mean not one. The more times I have to move my hands from the keyboard to the mouse, the more (angry) I get.”

Of fonts, space, autosave and insert.  For the love of god, make fonts bigger; use up all the free space. And autosave! Nothing is worse than a computer crashing or being called away mid-note only to find it's gone and you have to start over. Having the ability to INSERT free text anywhere in the note is also great. Sometimes, I really can't explain the nasty gangrenous foot with the provided responses in the drop down.

Standardize training. “I think it's wonderful that EMR companies have laid out very clear and simple instruction manuals and have provided classroom training with live-person Go-Live support and training a dedicated team of superusers, but…standardize the training.”

One commenter, recognizing that the industrial engineer who posted the question was charged with building an EMR system, wrote: “Thanks for all you do! I think the EMR is going to be a great thing eventually.”

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