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A look at unintended consequences of EHRs

The industry needs to focus on building EHRs that decrease medical errors and enhance patient care. By Lou Ann Wiedemann

chieving high-quality, cost-effective care requires an integrated healthcare delivery system that includes hospitals, providers, specialists and, in some cases, long-term care. Navigating this continuum of care can be fraught with twists and turns that are confusing to patients and their care providers. Medical errors, hospital-acquired condi- tions, rapid implementation of electronic health records (EHRs), fragmented delivery systems and technology constraints are just a few of the many issues affecting healthcare quality and patient safety today. In this healthcare environment, evidence of patient harm may not be glaringly obvious. For example, the in- terface between a laboratory system and EHR cannot be visualized by the healthcare provider. If high lab results indicating a myocardial infarction are not integrated into the EHR, thus notifying the clinical care providers im- mediately, several hours may pass before the patient’s symptoms are treated. As a part of continuous efforts to improve healthcare, most providers and organizations are investing large sums of capital dollars in health informa- tion technology.


While there is some reasonable evidence that EHRs can reduce patient safety issues, we must remember that the EHR has also introduced a whole new category of events that cannot be ignored in the rush to implementa- tion. The healthcare industry needs to begin focusing on building EHRs that decrease medical errors and enhance patient care.

The cost of medical errors

Medical errors contribute to a significant loss of healthcare funds each year; the costs are often stagger- ing. According to findings commissioned by the Society of Actuaries (SOA), measurable medical errors cost the U.S. $19.5 billion in 2008. This report demonstrates an opportunity for the healthcare industry to increase quality and patient safety. In addition, the report demonstrates a need for decreasing the cost of healthcare and increasing efficiencies in the continuum of care.

24 February 2012

Since 2008, there has been no shortage of statistics indicating patient safety concerns and the cost of errors. Despite massive attempts to measure patient safety and increase quality of care, the Agency for Healthcare Re- search and Quality (AHRQ) reported in 2007 that patient safety improves at just 1 percent per year. EHRs have been promoted as the key ingredient to better care coordination, a decrease in healthcare costs and improvements in efficiencies. However, realizing all of these benefits is often more difficult than expected. As organizations and providers continue to invest heavily in EHRs and health information technology (IT), there is an increased need to see the benefits of these systems. In recognition of the continued challenges associated with using EHRs, AHRQ funded additional research to identify the unintended consequences of EHRs. The results of the research culminated in a guide designed to assist organizations and providers in anticipating potential problems associated with EHR implementations.

Unintended consequences

AHRQ defines unintended consequences as an un- anticipated and undesired effect of implementing and using an EHR. These unintended consequences include increased work for clinicians, unanticipated workflow changes and repeat requests for system changes or up- grades. As these consequences occur, end users become frustrated with the system and software. As frustration levels grow, end users begin to develop workarounds or revert back to paper processes. For example, a hospital has an electronic lab system that reports abnormal lab values. The physician prints out the lab report and adds handwritten remarks to the report. This handwritten information is not a part of the electronic version of the lab report and contains important clinical information. How does the organization incorpo- rate the changes into the health record?

Another example: An organization has implemented computerized physician order entry (CPOE). Upon enter- ing orders for a patient, the physician may be prompted


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