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
After meeting with Duncan, a physician asked him demographic
information such as where he lived, but Duncan only provided a
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.
Guides are available on the CHPSO website and additional
support is available by contacting
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