Are EHRs Helping or Hindering Patient Safety Efforts? (Part 1)

A recent Fortune magazine article claims that EHRs are "an unholy mess" that haven't led to any improvements in patient safety. Just how bad is it?

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Part 1 of 2

Last month, Fortune magazine published an article, “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong,” that was, to say the least, a critical look at that inability of electronic health records to reduce preventable patient harm.

“The U.S. government claimed that turning American medical charts into electronic records would make healthcare better, safer, and cheaper,” wrote reporters Erika Fry and Fred Schulte. “Ten years and $36 billion later, the system is an unholy mess.”

While that assertion might be a little strong, the authors, nonetheless, have a valid point.

Consider the Following

Today, the adoption of electronic health records (EHRs) among U.S. hospitals is nearly universal. According to a HealthcareIT.gov Data Brief, as of 2015, 96% of acute-care hospitals have implemented some form of EHR technology. What’s more, eight in 10 acute-care hospitals have implemented all the functionalities associated with a Basic EHR, up from less than one in 10 in 2008.

Even small, rural, and critical access hospitals are joining the EHR club. Although the adoption rate of these hospitals still lags acute-care hospitals, the gap is closing; at least eight in 10 small, rural, and critical access hospitals have adopted Basic EHRs, which include 10 computerized functions, such as physician notes and nursing assessments, patient medication lists, electronically viewing laboratory reports, and electronically ordering medications.

Yet, despite the widespread adoption of electronic health records, we have yet to see any tangible improvements in patient safety.

The Facts Speak for Themselves

In 1999, the Institute of Medicine, in its landmark publication, “To Err is Human: Building a Safer Health System,” reported that at least 44,000 people, and perhaps as many as 98,000 people, die in U.S. hospitals each year because of preventable medical errors. In 2016, a study by Johns Hopkins revised that number to more than 250,000 people, making medical errors the third-leading cause of death after heart disease and cancer.

Other studies report much higher figures, claiming the number of deaths from medical errors to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners, and medical examiners rarely note on death certificates the human errors and system failures involved. Yet, death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.

Deaths from medical errors are increasing as EHRs are seen as roadblocks for delivering quality patient care.

According to a report published by the American Medical Association and the RAND Corporation, cumbersome EWR workflows and confusing interfaces are a significant source of stress for providers and are the biggest obstacles to providing the best possible patient care services. In addition, EHR issues are contributing to high levels of physician disgruntlement that may serve as an early warning sign of deeper problems in the healthcare system.

The EHR Blame Game

Backlash against poorly designed EHR systems is not new. In fact, an overall feeling of skepticism and frustration with electronic health records has been well documented for the better part of a decade. For instance, in a 2014 letter published in the Journal of the American Medical Association, it was reported that EHRs are causing physicians to lose an average of 48 minutes per day, while a Medical Economics poll6 stated that 67% of providers are unhappy with their EHR functionality.

U.S. healthcare is now faced with the dilemma of improving patient safety and reducing preventable patient harm in the face of EHR issues.

CMS Penalties at an All-Time High

Adding insult to injury, the EHR systems that were supposed to drive improvements in patient outcomes are now being used to penalize the very hospitals that have implemented the technology. With the adoption of EHRs came robust reporting capabilities, making it easier for the U.S. government to track performance mandates that are linked to financial incentives, including penalties related to preventable patient harm.

For instance, just a few weeks ago, the Centers for Medicare and Medicaid Services announced that 800 hospitals will see their Medicare payments cut by 1% – up from 751 hospitals the year before – because they reported high rates of patient injuries. (We wrote about this in our March 13 blog, “Using Technology to Avoid CMS Penalties.”)

Even worse, 110 hospitals are being punished for the fifth-straight time, including Miami’s Jackson Memorial Hospital, the nation’s third-largest hospital with 1,756 beds and $1.2 billion in revenue. Jackson, which is also Florida’s largest hospital by revenue, will lose roughly $2.9 million because of the patient safety penalty. If Jackson’s woes aren’t enough to get your attention, then consider this: The 800 hospitals penalized this year are the most since the federal government launched the Hospital-Acquired Conditions Reduction Program five years ago. Although the program was supposed to incent hospitals to implement improvement programs to avoid the penalty list, more and more hospitals are finding themselves on this list and facing financial sanctions.

However, while few are willing to argue that EHR technology has made a considerable contribution to reducing preventable patient harm and making healthcare safer, all is not lost either.

We’ll tell you why in Part 2 of, “Are EHRs Helping or Hindering Patient Safety Efforts?” which will be published on Wednesday, April 24.

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