Electronic Health Records: First, Do No Harm?

One of the top stated goals of the federal Meaningful Use program encouraging adoption of electronic health records (EHR) technology is to improve patient safety. But is there really a cause-and-effect relationship between digitizing health records and reducing medical errors? Poorly implemented health information technology can also introduce new errors, whether from scrambled data or confusing user interfaces, sometimes causing harm to flesh-and-blood patients.

This is the issue we will tackle in our InformationWeek Radio show, Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST. My guest for the show will be Scot M. Silverstein, M.D., a consultant and professor in the Drexel University informatics program who researches the shortcomings of EHR software. He also tracks the literature on EHR risks and offers his interpretations on the Health Care Renewal blog, where he posts as InformaticsMD. Silverstein serves as an expert witness in cases involving malfunctioning EHRs or malpractice cases involving the reliability of evidence recorded in EHR systems.

Don't expect a simple answer to the question of whether digitization is making healthcare more or less safe, on balance. "People will say, it's got to be better than paper," Silverstein said, in an interview in advance of the radio show. The inherent superiority of digital data tracking winds up being more an article of faith than a solid argument, he said. After all, digital systems can also make mistakes on a much larger scale than mere humans. He points to a case in 2011 where a glitch in the digital prescription system used at Rhode Island's Lifespan health system caused thousands of patients to receive the wrong form of certain medications, simply because the system dropped a suffix for "long acting."

Health IT may be preventing errors, too. Ideally, a comprehensive digital health record would be indexed and searchable to prevent the sort of errors associated with not knowing a patient's medical history or allergies, with automated alerts to warn of undesirable drug interactions and otherwise prevent medical errors before they can happen. That's the future health IT advocates are working toward.

(Source: HealthIT.gov)

[Dive deeper into this critical topic. Tune into InformationWeek Radio's Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST.]

As an informaticist, Silverstein believes in the potential of health IT but adds, "I've been working really hard to promote the elimination of bad health IT from the marketplace." Meanwhile he takes issue with the categorically inflated claims about the benefits of EHRs, which are often treated as self-evident. In one recent post, he observed that federal health officials essentially had to eat their words when challenged to produce evidence. When the American Association for Physicians and Surgeons filed a Freedom of Information Act request for research supporting claims of the of the lifesaving importance of adopting EHR technology, the response that came back was this: "While our Office of E-Health Standards and Services works to implement the provisions of the [American Recovery and Reinvestment Act], we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives."

Safety unknown
One of the issues Silverstein highlights is that there is no systematic tracking of medical errors associated with EHR functionality or usability issues, making it hard to judge whether their net effect has been positive or negative. Yet there are troubling signs, in everything from academic studies to malpractice claims, that the risks of EHRs have been underestimated and the rush to implement these systems may be misguided, he said.

"Quite simply, not only doesn't anybody know if health IT proves safety, but the infrastructure for studying it is not in place," Silverstein said. "Meanwhile, health IT is creating many new types of errors that wouldn't have happened before."

Just this month, the Journal of the American Medical Informatics Association published a study examining the safety issues associated with EHRs. The authors studied data drawn from the Department of Veterans Affairs health system, which has been aggressively implementing its own VistA EHR for more than a decade, making it one of the most mature implementations of health IT. One of their conclusions was that, while EHR safety issues may get more attention when the technology is first introduced, they persist

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