Computer systems that don’t “talk” to each other, test results that aren’t routed properly, and mistakes caused by faulty data entry or copying and pasting... these are some of the unintended consequences ushered in with electronic health records (EHRs).

Recognizing these emerging risks, CRICO has expanded its proprietary coding system to capture EHR-related problems that have contributed to patient harm. These data provide valuable insight to hospitals and clinicians so that these vulnerabilities may be addressed. The following tips were developed based on what we saw in our early analysis of these data.

  • To prevent, detect, and mitigate problems caused by duplicate record, patient mix-ups, and commingled records, check the patient ID to ensure that you are in the correct patient record.
  • Document conversations, even online communications, into the patient record when the information is pertinent to clinical care decisions or treatments.


  • Review and update allergies prior to entering any medication orders.
  • For children, if not built into the EHR, use weight based dosing recommendations, age appropriate dosing calculators, dose range checking, and pedi-specific drug-to-drug interaction.

Close loops in communications

  • If your institution’s EHR process does not facilitate both cancellation and acknowledgment of receipt of orders for labs, radiology, and pharmacy, then make sure to close this loop.
  • Electronic messaging needs to include the urgency of a message and closed loop communication in order to ensure clear, active receipt.
  • Be aware of, and use when appropriate, clinician decision support (CDS) tools in the EHR.
  • Minimize the use of free text for order entry.

Be alert to avoid faulty data entry:

  • Minimize the use of copy and paste, as this may repeat incorrect information.
  • Be aware of the measurement system the EHR uses (U.S. Customary Units vs. Metric System).
  • Make sure that the data you enter hasn’t been automatically converted to incorrect data. This is especially important with numbers, i.e., if you enter 2.5 make sure it isn’t converted to 25.
  • Make sure you enter information into the correct field.

This page is an excerpt of a full issue of Insight.

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CME: The Massachusetts Board of Registration in Medicine has endorsed each complete issue of Insights or 30-minutes of podcast episodes as suitable for 0.5 hours of Risk Management Category 1 Study in Massachusetts. You should keep track of these credits the same way you track your Category 2 credits.


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