Electronic health records (EHRs) have largely replaced written medical records in hospitals across the country to reduce human error that could result in patient injury or death. However, a study found these new systems may be failing to do their job.
In fact, researchers at University of Utah Health, Harvard University and Brigham and Women’s Hospital discovered EHRs failed to detect up to 33% of medical errors in study simulations, according to the report published Friday in an issue of JAMA Open Network.
Dr. David C. Classen, study author and professor of internal medicine at University of Utah Health, said EHRs are failing to save lives by ensuring safe use of medications. These systems were created to issue warnings to doctors if their orders for medication could result in allergic reactions, adverse drug interactions, excessive doses or other potentially harmful effects.
“In any other industry, this degree of software failure wouldn’t be tolerated,” Classen said in a news release. “You would never get on an airplane, for instance, if an airline could only promise it could get you to your destination safety two-thirds of the time.”
Scientists presented more than 8,600 simulated scenarios to different EHR systems in over 2,300 hospitals across the country from 2009 to 2018. The study used the Leapfrog CPOE test, an assessment of how a health system has designed and configured their inpatient computerized provider order entry functionality, to evaluate scenario outcomes.
Almost all of the scenarios were based on cases that harmed or killed patients in the real world.
For instance, one scenario was based on a 52-year-old woman admitted to the hospital with pneumonia. Prior to hospitalization, she was taking a blood thinner for a blood clot located in a vein deep inside her body. After she was hospitalized, she was given that blood thinner three times a day. She died of a large hemorrhage directly related to the overdose.
EHRs were first introduced to hospitals in the 1960s, according to the study’s news release, but were widely adopted after a 1999 report from the Institute of Medicineestimated as many as 98,000 people die in any given year from medical errors that occur in hospitals.
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While technology has greatly improved from 2009 to 2018, researchers found EHRs only modestly improved during the study’s 10-year span. In 2009, EHR systems issued warnings or alerts about potential medication problems about 54% of the time. By 2018, the number increased to 66%.
Experts say hospitals and federal regulators play a big a role in EHRs effectiveness to detect medical errors. Hospital struggles to keep up with software updates as discoveries in drug safety research continue to change recommendations and guidelines. That means EHR performance can vary from hospital to hospital.
“Hospitals decide what drug-related decision supports to turn on within their systems. They have a great latitude around this,” said Dr. David W. Bates, study co-author and chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital in Boston.
Federal regulators only inspect systems with factory specifications and don’t look at alterations or updates made after installation.
A spokesperson for the Office of National Coordinator for Health Information Technology at the U.S. Department of Health & Human Services said health IT has reduced medical errors overall and suggestive research shows “a very small percent” of medical errors can be attributed to it.
“While the use of electronic health information does not guarantee that there won’t be adverse events, the government continues to work to improve the safety of healthcare with the use of health IT,” the office said in a statement sent to USA TODAY.
Dr. Allison Weathers, Enterprise Associate Chief of Medical Information Officer at the Cleveland Clinic, said the study’s results shouldn’t be interpreted as a direct translation to EHR safety performance in the real world as outcomes were evaluated through the Leapfrog CPOE test.
She argued that while parallels have been shown between the test and medical error rate, the score a health system receives isn’t a direct relation to how many medical safety events would happen at a hospital.
“It’s a helpful guidepost to enhance EHR systems but not an exact one to one correlation of safety performance,” she said.
However, she argued such studies are still important as “they raise awareness for significant issues and ways to enhance our system.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.