Provider-provider Communication: How Does Your EHR Measure Up?
An EHR can help promote patient safety, but its success is implementation-dependent. Hospital leaders conduct an assessment of goals for technical readiness. Along with the vendor, the hospital outlines an implementation plan. The plan is implemented, a group of hospital staff members are trained, and they go through a mock “go-live” and pilot test. An actual “go-live” goes without a hitch, perhaps a few minor glitches, but essentially, the EHR is implemented.
Often, this is not the end of the work. As more hospital employees are trained on the EHR, they may become confused with the displays, others may find that the software is not always configured properly and the system appears complex. Successful EHR implementation is very difficult and the system needs continual close attention for improvement.
A study in 2013 by the American College of Physicians set out to understand how satisfied clinicians are with EHR technology. The results, as they turned out, were unsatisfyingly low. Thirty-four percent of clinicians were not as productive as they were pre- EHR adoption, an increase from 19 percent in 2010. In 2012, thirty-two percent of clinicians found that their workload was not decreasing, compared to 20 percent in 2010.
In the case of Thomas Eric Duncan, the first Ebola Virus Disease (EVD) patient diagnosed in the USA, the EHR configuration did not sufficiently support nurse to physician communication. Critical information present in the EHR at the first hospital visit was not recognized by the physician. In a recent NPR interview, Texas Health Resources’ Clinical Director, Dr. Daniel Varga, shared a few lessons learned:
The nurse who met with Duncan upon his first visit to the hospital documented his travels into Presbyterian’s electronic record system.
After meeting with Duncan, a physician asked him demographic information such as where he lived, but Duncan only provided a local address.
Duncan returned to the hospital two days later and was critically ill with Ebola.
Texas Health has since modified its EHR in multiple ways to increase the visibility and documentation of information related to travel history and infectious exposures related to EVD, including better placement and title of the screening tool, expanded screening for EVD exposure and high-risk activities, and embedded EVD clinical decision support.
With the complexities revolving around EHRs, hospitals and other health care organizations may struggle to optimize the safety and safe use of EHRs. The Federal Government has issued the SAFER guides to help hospitals review EHR implementation and identify areas of improvement. CHPSO was among six quality oversight and patient safety organizations to review guidelines and dissemination plans, along with the ECRI Institute, Institute for Safe Medical Practices (ISMP), The Joint Commission (TJC), National Patient Safety Foundation (NPSF) and Pascal Metrics. These Safer Guides are available on the CHPSO website and additional support is available by contacting CHPSO.
American College of Physicians. Survey of Clinicians: User satisfaction with electronic health records has decreased since 2010. 5 March 2013. Also presented at the 2013 HIMSS Conference & Exhibition as Challenges with Meaningful Use: EHR Satisfaction & Usability Diminishing. www.acponline.org/pressroom/ehrs_survey.htm