“EHR implementation is still highly heterogeneous across health care systems and providers, and this heterogeneity leads to equally variable implications for patient safety,” write Dean Sittig, Ph.D, and Hardeep Singh, M.D., in the current New England Journal of Medicine. “For instance, the priorities for patient safety in an organization in the midst of an EHR rollout differ from those of an organization that has used a fully integrated EHR system for 5 or more years.”
Sittig is a professor at the University of Texas School of Biomedical Informatics, and Singh serves as an assistant professor at the VA Health Services Research and Development Center of Excellence and at Baylor College of Medicine in Houston.
To account for variables in organizational EHR experiences, they propose a three-phrase plan for developing EHR-specific patient safety goals, called e-PSGs. The first phase addresses safety concerns unique to EHR technology with a goal of reducing downtime and safety issues, such as miscommunication between components of the same EHR system (ordering sustained release medication in CPOE but erroneously mapped as immediate release medication in the pharmacy module).
The second phase would address mitigation of safety concerns from failing to appropriately use EHRs. “For instance, if CPOE is used to order medications but not laboratory tests, there would be no way of ensuring closed-loop electronic communication of test results to the ordering providers, potentially leading to more missed results,” the authors say. Consequently, one goal of the second phase could be to mandate CPOE for all medication, lab and radiology orders.
The third phase would use EHRs to monitor health care processes and outcomes, and identify potential safety issues before they cause harm. “To achieve the goals of many national initiatives to improve patient safety and to facilitate the prevention of safety events, electronic data must be used to help detect, manage and learn from potential safety events in near real-time,” according to the report, “Electronic Health Records and National Patient Safety Goals,” available here.