Despite improvements in their performance over the past decade, electronic health records commonly used in hospitals nationwide fail to detect up to one in three potentially harmful drug interactions and other medication errors, according to scientists at University of Utah Health, Harvard University, and Brigham and Women’s Hospital in Boston.
In tests using simulated medical records, they found that EHR systems consistently failed to detect errors that could injure or kill patients. The findings appear in JAMA Network Open.
WHAT’S THE IMPACT
First deployed in the 1960s, EHRs replaced written medical records and manual filing systems. They became almost universally adopted in the early 21st Century due to federal EHR incentive programs. Another incentive was an Institute of Medicine report which found that medical errors accounted for 1 million inpatient injuries and 98,000 deaths annually. According to the report, medication safety problems were the most frequent cause of preventable harm.
Medical professionals hoped that widespread use of EHRs would reduce this problem. The computerized systems are designed to issue warnings to doctors if their orders for medication could result in allergic reactions, adverse drug interactions, excessive doses or other potentially harmful effects. But findings suggest that medication safety and overall safety problems in hospitals continue to occur at a high rate despite the almost ubiquitous use of EHRs by hospitals.
One snag is that hospitals have to customize and adapt their EHR software to meet their own needs. This is a complex process that makes it difficult to keep up with all changes in drug safety. So, for example, a serious drug interaction that would trigger EHR warnings at one hospital might not at another one.
Hospitals basically decide which drug-related decision supports to activate within their systems, giving them a significant amount of latitude. But federal regulators only inspect EHR systems with factory specifications, meaning that whatever alterations hospitals make after installation aren’t taken into account.
To determine the effectiveness of EHRs in real-world settings, the scientists studied the results of tests conducted by an EHR safety evaluation tool called the Leapfrog CPOE EHR test, which simulated actual drug orders that have and could potentially harm patients. Almost all of the scenarios were based on actual adverse drug events that harmed or killed patients in the real world.
In one scenario, for instance, a 52-year-old woman was admitted to the hospital with pneumonia. Prior to hospitalization, she was taking warfarin, a blood-thinning medication, once a day to combat deep vein thrombosis. After admission, she received warfarin three times a day. This excessive dosage went undetected by the hospital’s EHR system for five days. As a result, the patient had a large hemorrhage and died of causes directly related to the overdose of warfarin.
Scenarios like this one were fed directly into EHR systems at 2,314 hospitals nationwide to see if their systems would perform better. All of the tests were conducted over a 10-year span, 2009 to 2018.
The researchers found that, in 2009, these systems correctly issued warnings or alerts about potential medication problems only 54% of the time. By 2018, EHRs detected about 66% of these errors, only a modest improvement.
THE LARGER TREND
One of the holy grails of EHRs is interoperability, or the ability for disparate EHR systems to communicate and share data with each other. Final interoperability rules, released in March, are expected to be implemented over the next two years, to boost the exchange of data through new Application Program Interfaces and FHIR standards.
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