Despite the potential for health information technology to improve patient outcomes, adverse events associated with the use of health IT can cause extensive harm and are encountered across all healthcare settings.

That’s the finding of a new analysis of electronic health record-related harm in cases submitted to a large database of malpractice suits and claims maintained by CRICO, an evidence-based risk management group of companies owned by the Harvard medical community.

Researchers identified 248 malpractice cases showing serious unintended consequences from the use of EHRs, representing less than 1 percent of all cases in the database. Of cases with causes related to EHRs, 80 percent involved moderate or severe harm. EHR errors were found to occur more frequently in ambulatory settings than in inpatient settings. Although ambulatory care accounted for more than half of the cases, deaths were more likely to occur in inpatient settings.

Published in the Journal of Patient Safety, the study reveals that most of the cases were filed as a result of an error involving medications (31 percent), diagnosis (28 percent) or a complication of treatment (31 percent). The results jibe with a September 2015 Institute of Medicine report citing EHRs for their contributing role in causing diagnostic errors.

“There are several key areas of technology within the EHRs that are vulnerable,” says Dana Siegal, RN, director of patient safety for CRICO Strategies and one of the primary contributors to the study. “We looked at both the system/design issues and human factor or user issues.”

According to Siegal, 58 percent of the medical malpractice cases had a system-related design or technology issue and 63 percent had a user-related or human factor issue, noting that cases could have more than one cause.

Among the EHR system issues she describes are “systems simply malfunctioning, not available, and not able to access data” as well faulty routing of “information intended to be sent to one place was sent to another.” All of this leads to “incorrect or missing data for clinicians waiting to use that data.”

Human factors in the studied medical malpractice cases included clinicians entering the wrong data. “That may or may not be a product of the EHR,” argues Siegal. “Was the data wrong because the drop-down field was difficult to use or manipulate, and in trying to click on one thing they accidentally clicked on another? Could be. We also know that copy and paste [capabilities] are issues that users get into trouble with by perpetuating data errors.”

In addition, Siegal says problems arise when clinicians keep hybrid copies of patient records—for example, information that exists on paper that’s not fully entered into the EHR. However, the severity of harm as a result of these kinds of errors seems to relate more to a patient’s particular condition than to any one class of error, she says.

“If you’re treating a patient and you miss an alert or some critical information, it may have less impact for a patient who’s being cared for in an ambulatory setting that’s not that acutely ill,” Siegal says. “The exact same error in an ICU may actually have a higher impact on the patient.”

A major obstacle to eliminating these kinds of errors is changing the medical culture in which providers are allowed to admit mistakes, concludes Siegal. “People are very reticent to come forward and say that they made an error,” she says. “But if we don’t know where the errors are, we don’t know how to fix them. We need to move to a culture of transparency.”

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