Why Is There No Reporting Of EMR Errors?
By Christine Kern, contributing writer
Subsidies are given for computerizing, but no reporting is required when errors cause harm.
According to The Boston Globe, the United States Government has “poured $30 billion in taxpayer subsidies into the development of digital medical records beginning in 2009, with only a few strings attached and no safety oversight of the vendors who sell the systems.” Touted as a way to improve patient care and rein in skyrocketing medical costs, the move has actually created new risks for patients, the scope of which are still not fully comprehendible.
The article states, “From 2008 to 2013, the percent of U.S. doctor’s offices with electronic health records rose from 17 percent to 48 percent. The increase in hospitals was even more dramatic, growing from 13 to 70 percent.” The growth has come at a price however. Lack of reporting and tracking of the digital systems, have led to “unsafe conditions, injuries, and deaths.”
A recent study of malpractice claims, by safety researchers for a Harvard-affiliated malpractice insurance group, CRICO, produced an unsettling glimpse into the problem. Sifting through a large database of malpractice claims from Boston and other healthcare centers around the country, the researchers searched for cases in which the use or misuse of electronic heath records was suspected of causing harm.
They discovered 147 instances in which electronic health records contributed to “adverse events” that affected patients — half of them designated as serious. The cases were culled from a one-year period of newly filed malpractice claims overlapping 2012 and 2013, a total pool of around 5,700 cases.
Forty-six of those events resulted in patient death, CRICO officials told the Globe — a toll that before now has not been disclosed publicly. Among the most frequently cited examples of harm in the review was the faulty use of “hybrid” paper and electronic records.
The analysts also identified as hazards: medical staff entering incorrect data; improper use of a computer’s “cut-and-paste” function to duplicate, without updating, daily notes on patients; and computer crashes that caused loss of data and left medical staff temporarily without access to critical records.
The systems can be complex, time-draining, and frustrating to use, especially early on. Hospital staff members routinely override automatic warnings, cut corners, and develop “workarounds” as they struggle to balance caring for patients with the demands of cumbersome drop-down menus and other forms that appear on their computer screens.
White House officials sold the concept with claims that widespread use of computers in hospitals and doctors’ offices would improve patient care and save tens of billions of dollars a year. Those claims have yet to be realized, and the estimates of cost savings have thus far turned out to be dramatically overblown. Specialists in the field recognize that medical errors and “near misses” related to digital records — many inconsequential, but some serious — are a threat that needs more attention.
In 2011, the Institute of Medicine said the lack of a central repository for reporting error-prone software, patient injuries, and deaths, combined with nondisclosure and confidentiality clauses in vendor contracts, “pose unacceptable risks to safety.”
It strongly recommended that the Obama administration mandate that vendors report “deaths, serious injuries, and unsafe conditions” to a centralized, government-designated entity, and de-individualized reports should be made available to the public.
Three years later, no such reporting system exists but safety problems still do in the implementation and use of EHRs and, in order to fully realize desired savings, these errors and misuse of the digital systems must decrease. Healthcare providers and specialists must continue to modify and improve digital systems in order to increase their effectiveness. Also, more intense system training must be provided to health care professionals in order to reduce the associated human error.
Health care authorities urgently need to fill in the blanks, said Dr. Alan Brookstone, a physician and cofounder of a service that rates the performance of digital records systems. “Is this technology doing the job right? Is it doing it safely and accurately?” he said. “There’s almost like a missing link.”