Some features of electronic health records and related apps are unintentionally contributing to incidence of patient harm, according to a report from the Maryland Department of Health and Mental Hygiene.
In fiscal year 2013, the department's Office of Health Care Quality received "numerous" reports of patient harm resulting from IT processes or glitches.
For example, one hospital did not realize its electronic "Ticket to Ride" handoff tool automatically defaulted to categorizing the patient as low fall risk until a patient suffered a serious fall.
At another hospital, the EHR was not designed to flag potentially dangerous radiology or cardiac diagnostic findings. A patient was discharged following a carotid ultrasound, the results of which showed massive blockage but were not flagged in the EHR and were therefore not studied closely. The patient died a week later from a stroke.
A patient at another hospital suffered a medication error when an emergency department physician entered a medication order into the wrong patient's chart. That ED's EHR system allowed multiple records to be open at once, which the report cites as facilitating the error.
Based on the EHR-related incidents reported to the DHMH, the department recommends hospitals and health systems examine their EHRs to ensure the following:
- Lab and diagnostic systems send an automatic prompt to the ordering physician when the results are entered into the EHR
- Before posting, discharge summaries flag pending results and the current medication list
- Risk assessments are tied to recommended interventions
- Each section of the EHR is hot-linked to the appropriate policy on the hospital's intranet for quick reference
- If the EHR allows for more than one patient record to be opened at a time, the hospital should determine if it is clear which patient's record is being accessed
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