JCR and JCI Consultants on Reducing and Preventing EHR-related Safety Events
Becker’s Health IT and CIO Review recently reported that the number of Electronic Health Record-related (EHR) lawsuits in the United States doubled between 2013 and 2014.
We spoke with JCR and JCI consultants to get their opinions on how to prevent, mitigate, and react to EHR-related safety events. Jeannell Mansur, RPh, PharmD, FASHP, FSMSO, CJCP; R. Michael Boyer, DO, MS, FAOCA;and Francine Westergaard, RN, MSN, MBA,have assisted organizations in the United States and around the globe in tackling their toughest quality and safety challenges.
Q: In your opinion, what are the most common causes of an EHR-related safety incident?
Mansur: There are many ways that an EHR can contribute to a patient safety event. Often, safety events can be related to user error. For example, it is relatively easy to inadvertently enter information on the wrong patient when the user is multitasking and has several records open at once.
In my experience, I also see issues pertaining to the quality of the build of the EHR, where medication records may not be built in optimal ways to support patient safety. Information could also be displayed to end-users in a way that leads to misinterpretation. Often, workflows that are now altered by EHRs are not evaluated and redesigned, and that can lead to process failures and other new sources of potential errors.
Boyer: Typical root causes of EHR-related safety events include deficient vendor or institutional EHR builds, limited EHR interoperability, deficient provider EHR education, and poor post-deployment vendor or institutional support. Additionally, internationally and domestically, there are misunderstandings as to what EHR best practices are, and as to the technology’s greater purpose.
Health care IT is at a crossroad. Domestically, EHR vendors and health care institutions have recently been consumed with “Meaningful Use” and “ICD10.” As such, some have lost sight of an EHR's purpose – to improve patient care.
Westergaard: I have noticed some common misconceptions among many international organizations at the beginning of the EHR implementation process. There is a perception that the introduction of and EHR is going to resolve many of the challenges associated with documentation. However, some organizations that do not have a well-organized paper medical record cannot describe what they want in an EHR. As such, the vendors provide them with a product that may not meet their needs. This causes physicians and staff to begin using work arounds almost immediately after implementation.
The amount of training that is provided on the new EHR system is often insufficient, and those that would benefit the most from the training often don’t attend until the very end. This causes the education process to be rushed or compromised. Also, many people are afraid to admit when they don’t feel comfortable with the new processes. Some feel they understand it during training, but cannot replicate a process after training. These and other contributing factors result in safety events, many of which are not identified immediately.
Q: What do you think can be done to decrease the number of EHR-related safety mistakes?
Mansur: I believe we need to make end users aware of the potential this technology has to contribute to safety events and to encourage the reporting of events that may be related to EHRs.These are important features that can be found in high reliability organizations as they promote a healthy culture of safety. If an EHR-related safety event occurs, the event should be analyzed. The organization should then make changes to address the root causes. Resources should be available to address post go-live optimization.
Boyer: First and foremost, health care organizations should have an evidence-based, impartial, patient safety inventory of their EHR. Third party consultants like those at JCR and JCI can help guide organizations through this process. Independent consultants can use patient safety and standards and processes as the structure for appraisal and guidance. Then, consultative and constructive recommendations can be made as to best-practice next-steps.
Westergaard: Third party consultants can assist organizations at the beginning the EHR system selection process. They can help an organization define what they would like in a product and how the end result will assist with communications, meet standards, and mine data. JCI Consultants have acted as liaisons between health care organizations and their EHR vendors. For those organizations that have already implemented an EHR, we are often asked to provide guidance on how to use the EHR as a tool to identify safety events. We help clients analyze these events and then implement strategies to minimize risks going forward.
Q: Are there any EHR-related Joint Commission or Joint Commission International standards that organizations should focus on in order to prevent these incidences?
Mansur: There are a great number of Joint Commission domestic standards that are applicable for hospitals using EHR technology. Some of the most important come from the Leadership chapter. The chapter focuses on a leader’s role in defining safety priorities. This includes supporting performance improvement through promotion of a culture of safety, and the allocation of resources to patient safety and performance improvement activities.
Boyer: Many Joint Commission International standards include elements regarding communication, transparency, coordinated care, documentation, culture of safety, and leadership. In my opinion, the Management of Information chapter has some of the best standards for addressing EHR-related safety issues. This chapter also doesn’t require a significant amount of EHR-specific modifications to the existing standards.
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