Electronic health records (EHRs) provide physicians the data and tools to ensure better patient care and many providers rely on medical transcription companies for documentation support. Outsourcing medical transcription helps providers manage their EHR data entry tasks efficiently. However, according to a new study published in Health Affairs, poor EHR design can lead to errors that compromise patient safety. The researchers found that usability of EHRs accounted for more than a third of medication errors noted in 9000 pediatric patient safety event reports.
Led by Raj Ratwani, director of the National Center for Human Factors in Healthcare at MedStar Health, the study defined usability as “the extent to which the technology can be used efficiently, effectively, and satisfactorily” based on system design and customization to specific workflows. With physical characteristics that differ from adults, children may be at greater risk of harm from poor EHR usability.
The four general usability categories and warning signals for EHRs were listed as:
- System feedback (inappropriate)
- Visual display (clear, confusing, or cluttered)
- Data entry (difficult or impossible)
- EHR workflow and clinician expectations (mismatch)
The study looked into nine types of medical errors defined by the National Medication Errors Reporting Program of the National Coordinating Council for Medication Error Reporting and Prevention: improper dose, wrong strength/concentration, wrong drug, wrong dosage form/technique/route, wrong rate, wrong time, wrong patient, monitoring error, and “other”.
The team evaluated 9,000 patient safety reports from three healthcare organizations from 2012 through 2017. They found that the general pattern of usability challenges and medication errors were similar across the three sites. The key findings of the study are as follows:
- Each organization reported approximately 50,000 patient safety events over the 5-year study period
- Of the 9000 patient safety reports, 36% had an EHR usability issue associated with the medication error, and 18.8% may have caused patient harm
- The most common EHR usability problems were related to system feedback (82.4%), followed by visual display (9.7%), data entry (6.2%), and workflow support (1.7%)
- The most frequently reported medication error for all three sites was improper dose (84.5%), followed by “other” (5.9%) and wrong time of administration (3.5%)
The researchers warned that thousands of pediatric patients might be at risk due to EHR usability issues. They recommend that Office of the National Coordinator for Health Information Technology (ONC) add safety with the voluntary certification criteria of EHRs for use with children and include usability measures to assess EHR performance.
Another study from the Pennsylvania Patient Safety Authority also reported that computerized prescriber order entry (CPOE) systems and pharmacy systems are the most commonly reported factors contributing to medication errors. Opioids, insulin, and anticoagulants – all high-alert medications – were three of the top drug categories involved in reported events. The study found that every step of the medication use process involved health IT-related errors.
Errors in medication represent a significant number of medical malpractice cases in the United States, according to a www.hg.org article. These cases deal with negligence by the physician or nurse and include issues such as:
- Not documenting patient history
- Not recording allergies leading to prescribing errors
- Prescribing errors can involve the wrong dose, form, quantity, administration route, concentration, or rate of admission
- Communication breakdowns leading to lack of clarity on current or updated information, which could result in an overdose
- Omitting to give the medication before the next one is scheduled
- Giving a medication outside the predetermined interval
- Wrong formulation of a medication
It is critical to resolve EHR usability concerns and improve physician engagement and ensure access to reliable medication histories by the next providers of care. Accurate documentation translates to accurate recording of the drug information, the name of the drug, the dose, route, time, patient response, and any refusal of the drug by the patient. However, nurses can make errors while transcribing medication orders due to stress and distraction, lack of proper documentation, memory loss, and systemic problems such as wrong labeling, etc. Medical transcription outsourcing can play an important role in improving nursing transcription. An experienced medical transcription service provider can provide error-free, timely transcription of history and physical reports, clinic notes, office notes, or operative reports, allowing clinicians to ensure proper documentation and reduce the risk of EHR-related medication errors.