Most doctors say patient health, safety jeopardized by EHR outages
More than half of U.S. physicians indicate that the health or safety of their patients was put in jeopardy because of an electronic health record system outage.
That’s the finding of a new survey by SERMO, a social networking website exclusively for doctors.
According to the Office of the National Coordinator for health IT, EHR outages represent a significant potential patient safety hazard that directly affects patient care, raising the likelihood of increased risk of medication errors, lack of access to images and canceled procedures.
In addition, ONC warns that the potential impact of EHR unavailability—both planned and unplanned—increases as such systems are deployed across multiple, geographically dispersed facilities within a healthcare system.
“As we have become more successful deploying EHRs, we have an increasing percentage of the clinical workforce that has never practiced healthcare without an EHR,” says Andrew Gettinger, MD, ONC’s chief medical information officer. “Their ability to go back to paper-based systems is very different than when we started on this journey and everyone knew what to do when the systems were out.”
Gettinger, who is also executive director of the Office of Clinical Quality and Safety, cautions that healthcare organizations can never expect to have 100 percent EHR uptime and that inevitably clinicians will not be able access all or part of their EHRs because of software and hardware failures, power outages, as well as natural and man-made disasters.
“The duration of an outage creates an increasing amount of work when you resume your electronic systems. And, different organizations have different strategies for how they backfill the content and make sure they don’t miss things along the way,” he adds.
To prepare providers for such eventualities, Gettinger recommends that organizations conduct practice drills for how to operate during EHR outages. “You have to prepare ahead of time—there will always be outages.”
In the SERMO poll, a total of 3,086 global physicians responded—of which 1,678 identified themselves as U.S.-based physicians.
While the majority of American doctors (55 percent) did report that the health or safety of a patient was put in jeopardy because of an EHR outage, the majority of physicians globally (54 percent) said the well-being of a patient has never been in jeopardy because of an EHR outage.
In fact, doctors in countries with public healthcare systems such as Canada (54 percent), the United Kingdom (54 percent), France (61 percent) and Germany (91 percent) all indicated that they’ve had no health or safety issues as a result of EHR outages.
Nonetheless, Gettinger is not surprised by the difference in experience between U.S. and international physicians when it comes to patient safety and EHRs.
“There is about a 10 point difference between the European and U.S. physicians in the poll,” observes Gettinger. “That speaks to how EHRs are implemented. In the United States, there is way more fragmentation than there is in Europe, where implementation is done in a more standardized way across countries. Here, we have much more diversity as that’s done.”
Recently, ONC updated its Safety Assurance Factors for EHR Resilience (SAFER) guides to help providers assess the safety and usability of their respective EHRs. The guides include a Contingency Planning Guide that identifies recommended safety practices associated with planned or unplanned EHR unavailability or downtimes, when systems are partially (response times are unacceptably slow) or completely unavailable.
EHR unavailability “can introduce substantial safety risks to organizations that have not adequately prepared,” states the guide. “Effective contingency planning addresses the causes and consequences of EHR unavailability, and involves processes and preparations that can minimize the frequency and impact of such events, ensuring continuity of care.”
Gettinger contends that EHR safety and effectiveness can be improved by establishing proper downtime procedures, policies, and practices—as outlined in the SAFER guides—including contingency plans and back-up systems.
Still, he acknowledges that small practices will never have the “kind of IT expertise that’s necessary to keep systems up and running as smoothly as we’d like.”