Emergency Department EHRs Raise Quality, Safety Concerns


An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

  • Appoint a “clinician champion” to act as a liaison between doctors;

  • Have vendors and hospital leadership form a multidisciplinary performance-improvement group;

  • Set up an ongoing review process to monitor patient concerns in a timely manner;

  • Measure and share lessons learned; and

  • Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

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