EHR Vulnerabilities Lead to Severe Harm, Death for Patients

Samara Rosenfeld
JULY 08, 2019
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Photo/Thumb have been modified. Licensed by Creative Commons Zero - CC0.

Adverse events related to health information technology (IT) and electronic health record (EHR) vulnerabilities are associated with incidence of severe harm and death, according to the findings of a study published in the Journal of Patient Safety.
 
Researchers conducted a mixed methods analysis and found that more than 80% of cases submitted to the CRICO claims database coded during 2012 and 2013 involved moderate or severe harm. Investigators also found that cases were typically filed due to a medication error (31%), complication of treatment (31%) or diagnosis (28%).
 
The CRICO Comparative Benchmark System is a national database of medical malpractice claims that reflect hospital and clinician risk across all care settings. Researchers analyzed 248 open and closed malpractice claims and suits, which were filed with regard to injuries that occurred during the provision of healthcare services from 2008 to 2014. The claims had codes of one or more EHR identifier as a contributing factor in the case.
 
A majority of the cases (146) came from the ambulatory setting. Ambulatory errors outnumbered errors from inpatient care and the emergency department for every major service except for nursing. Medication-related issues had the most claims, followed by surgery, nursing, obstetrics and gynecology and radiology.
 
The leading contributing factor in the ambulatory setting dealt with problems related to hybrid record systems. More than 10% of cases in the inpatient setting came from system design issues, breakdowns in communicating data and incorrect information in the EHR.
 
The two main categories of EHR-related contributing factors included system-related issues (58%) and user-related issues (63%).
 
System-related issues included cases that involved a problem with technology or software design that adversely affected patient outcomes. For example, in at least one case, a patient might have died due to the delay of an order for blood.
 
User-related issues included training and education. In one case, a physician received an alert noting that a patient was allergic to amoxicillin, but the doctor ordered the medication anyway, leading to an allergic reaction.
 

How Health Systems Can Improve the Safety of EHRs

“Healthcare professionals, their organizations and health IT vendors can decrease the risk of harm related to using (EHRs) by appreciating and addressing the lessons that these cases provide,” the study authors wrote.
 
They identified several themes across cases where providers and their organizations could begin improving the safety of EHRs:
 
  • Danger inherent in hybrid systems and EHR conversions.
Researchers saw many examples of problems that could lead to harm or injury when organizations transitioned their EHR systems. Transitions need defined action plans and appropriate resources to ensure complete and accurate data are available as soon as possible. Providers must be aware that during transitions, there is an increased risk that the data needed for safe patient care could be missing or incorrect.
  • Danger of delayed, missing or incorrect data, services or actions.
Malpractice claims came from limitations created by the EHR to provide correct information needed for safe care. Problems increased when providers thought their EHR system was working properly, even though it wasn’t. Providers must be aware of vulnerabilities to ensure follow-up on ordered tests, validate data or inquire about delayed services or products.
  • Danger of overreliance on EHR.
Providers should be vigilant when using EHR data and verify and recheck the information.
 

How Vendors and Executives Can Improve the Safety of EHRs

  • Routing problems.
It is necessary to ensure the correct routing of data and services. Teams need to understand how and why data could be mis-routed and develop solutions to address the system and user contributions.
  • Pre-population.
It is important to explore the time-saving value of pre-populating data due to the vulnerabilities it produces.
  • Intrinsic cross-checking.
EHRs should have the ability to detect the slighting error in ordering. Predictive analytics could prevent these errors.

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