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Making EHRs Safer for Patients and Providers


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Making EHRs Safer for Patients and Providers

By Luke Sato, MD, CRICO

Related to: Clinical Guidelines, Communication, Diagnosis, Electronic Health Records, Emergency Medicine, Primary Care, Obstetrics, Surgery

Health information technology (HIT) systems are key to reducing opportunities for medical errors—and they are continuously increasing efficiency, reducing risk, and keeping malpractice frequency low.(1) Nonetheless, the errors that do prompt malpractice cases provide us with a unique view into the mechanics of how health care is being delivered…and where systems break down. Thus, some malpractice cases can be considered as HIT use-case scenarios: examples of where implementation of select IT solutions could have prevented a medical error and impacted the safety of care being delivered at that time. These are particularly evident in two major categories of concern:

  1. Cases stemming from a lack of decision-making where an individual clinician’s knowledge and judgment comes into play. In other words, cases which could have been mitigated if the providers had access to systems that assisted them in making the right decision.

  2. Cases with a lack of follow-up and communication—after the provider made the right decision. In these cases, we see a process that fails the provider by not carrying out his or her intended actions, thereby allowing important steps to be missed.

The holy grail of health care’s technical revolution is finding HIT solutions that guide clinicians through logical and evidence-based decision making, and then ensure that providers and patients follow the appropriate steps to close the loop for optimal diagnosis and treatment. To that end, CRICO convenes a Technology Task Force (TTF) to address cross-institutional risk and patient safety issues. Among other achievements, we hope to leverage federal Meaningful Use requirements (2) to simultaneously cover key areas of patient safety. And, if the TTF can define best practices, we would, perhaps, be positioned to define the standards in this domain on a national basis.

1. In the CRICO system, the number of malpractice cases filed averaged 2.3 per 100 insured physicians over the past 10 years. The rates for each of the most recent four years, were all below that average. In 2010, the rate was 2.2 per 100 insured physicians.

2. Meaningful use refers to criteria for what an electronic health record (EHR) should be able to do. CMS is creating guidelines on how EHRs should be used by health care providers and hospitals to improve the quality, safety, and efficiency of the health care system. To achieve meaningful use, health care providers and hospitals must meet the criteria created by the ONC and CMS.

April 1, 2011
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