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New Study Shows Link Between EHR Usability Issues and Medical Errors

Authored by: Steve Hunt

A patient’s electronic health record (EHR) is a deep vault of medical information. And nowadays, the problem is rarely about having enough data – it’s the accuracy of that data and getting access to it. 


According to a recent study published by JAMA Network Open, a critical area connected to accuracy is EHR system usability. The research found that EHR systems that are challenging to use are also less likely to catch medical errors that could harm patients.  


As you consider the implications of EHR issues, a few critical areas to review are connected to data quality and patient care.  

1. EHR issues: Inaccurate coding 

As medical professionals know, the number of International Classification of Disease (ICD) codes has significantly increased over time. I’ve heard good-natured jokes about a new code for everything, such as “getting bitten by a shark on a Tuesday afternoon.” (I’m joking, of course, but you get the idea.)  


Wrong or missing ICDs can impact care transitions and also have major effects on providers getting paid. These inaccuracies can create challenges for future providers attempting to understand a patient’s complete medical history, resulting in their own EHR problems. 

2. EHR issues: Data disconnects and interoperability challenges 

Adopting an EHR system promised a future of less paper, greater efficiency – and fewer faxes.  


And yet we still often fax patient data.  


With no shortage of data and huge EHR files, continuing to fax has introduced even more significant challenges to find critical medical information that’s needed and therefore increases the risk of errors.  


I’ll give you an example.  


A treating practice needs to send patient information to a specialist for follow-up care.  In ‘the old days’ the provider would send a one or two-page progress note and potentially include a pertinent lab result or other medical documentation. Sure, the information they sent might be hard to read or might even be missing some crucial data, but at least it was still relatively short.


In the era of EHR, providers often struggle to locate and accurately transmit the critical information that specialists require. As a result, they end up collecting the progress note (typically 5 to 10 pages long in EHRs), a human-readable version of the Continuity of Care (CCD) document, all recent lab results for the patient, and possibly a ‘home-grown’ face sheet or referral letter template from their EHR. Instead of utilizing industry-standard digital exchange standards to electronically deliver the information, they package it all and still resort to sending it via fax. 


More than likely, the information the specialist needs is somewhere in the information, but it is now buried within 20 or 30 pages of information that was still received through a fax. 


On the receiving end, finding the key information needed and transferring all the included data into the patient’s file is challenging, and not everything makes it into the EHR.  


Maybe it’s the patient’s missing A1C level, which fell outside the normal range in a recent blood test, signaling diabetes. In the absence of this data, the new practitioner reruns the labs, adding further expense and inconvenience for the patient. Or maybe they don’t run labs. Instead, the patient is treated for a different condition and prescribed a drug that contradicts with a potential diabetes diagnosis, contributing to future risks due to a delayed diagnosis.

3. EHR issues: Usability challenges 

Let’s come full circle to where we started: problems with EHR systems related to usability.  


In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to promote the adoption and meaningful use of EHR systems, and financial incentives were provided to eligible healthcare professionals and hospitals.  


With a good amount of money available, EHR vendors hit the market with all types of solutions.   


Some of them were good, and some of them were not so good, and often providers were too busy seeing patients to properly vet EHR options. 


As a result, many practices purchased systems that weren’t the best fit – or what we call “clunky and unusable systems.”  


And this is what the JAMA Network Open study alluded to in its research.  


When the EHR system is not configured correctly, lack of training prevents its accurate use, or when the system lacks the features and functions that the practice needs to accurately document medical information in a timely manner, errors occur, and patient care (and the practice’s revenue cycle) is negatively impacted. 


For example, a patient might have a three-day inpatient stay. Due to issues with EHR usability, a practitioner inputs incorrect data. In addition to the fact that the practitioner might not get paid fully (or at all) for the services they provided, the next person might  compound that error, and the cycle continues. And now, suddenly, the patient’s medical record is out of whack. EHR issues: Breaking the cycle  


Providers are busy caring for their patients, and getting through the work in front of them each day is often challenging. Even though your existing EHR system might not be as efficient as it could be, it probably took you a lot of work to get where it is today. And you might say to yourself, “It’s been so painful to get to this point – we just don’t want to touch it.”  


But the reality is that EHR systems house critical patient data, and more than ever, practitioners need that data to be accurate. So, placing greater focus on getting your data correct so it can be used – and reused – holistically helps reduce overall healthcare costs, supports positive patient outcomes, and will have a positive effect on your own practice’s financial well-being.  


Every healthcare provider owes it to themselves, their business, their patients, and society as a whole, to ensure that the right EHR is being used in the right way to support a better healthcare industry for all of us. 

Do you need help with EHR issues and improving accuracy? We can help!  

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