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Community Hospital Blog

March 2016
Evaluate Your EHR for Improved Quality

by Amy Boykin, SVP Quality, Patient Safety and Care Management, CHC


Across the country, hospitals continue to make significant investments in the implementation, enhancement and use of electronic health records (EHRs). The use of EHRs to coordinate and share more complete patient information is widely recognized as a way to improve quality of care and patient safety. However, EHRs can also be a new source of medical errors with the potential for patient harm.


Inherent EHR challenges


A study in the Journal of the American Medical Informatics Association found that a majority of safety events identified in an earlier RAND Health study resulted from the EHR itself, rather than user error. Triggers include:


• Unmet display needs. Information presented on the screen did not address the clinical needs of the end user.


• Consequences of software modifications, including improperly configured software, upgrades and out-of-date software.


• Data exchange failures. Patient safety was compromised through poor patient-matching during data exchange or an inability to get necessary information from another hospital’s system during an emergency.


• Hidden dependencies within the EHR. For example, when an inpatient was transferred to an outpatient area temporarily, medication information was automatically deleted when the patient returned to the inpatient setting.


• Pre-populated default clinical information, such as “within normal limits,” can increase the risk of adverse events — and increase the risk of non-compliance with hospital and Medicare accreditation standards. Improper use of default function clinical information put patients and hospitals at risk. CMS surveyors finding inconsistencies may cite an immediate jeopardy finding and recommend termination from the Medicare program.


Mitigating risk: recommendations and resources


Recognizing these potential EHR risks, in March 2015 the Joint Commission released guidelines to prevent adverse events. Sentinel Event Alert #54 offered three key recommendations.

  • Safety culture. Create and maintain an organization-wide culture of safety, reliability and effective change management.
  • Process improvement. Develop a proactive approach to process improvement that includes assessing patient safety risks through tools such as Failure Mode and Effects Analysis (FMEA).
  • Leadership. Enlist multidisciplinary representation and support in providing oversight for health information technology planning, implementation and evaluation.

Additionally, the U.S. Office of the National Coordinator for Health Information Technology developed Safety Assurance Factors for EHR Resilience (SAFER) guides to help hospitals and healthcare organizations complete self-assessments to optimize quality of care and patient safety through the use of EHRs.


Put technology to good use


The EHR can improve quality of care and enhance the efficiency of documentation from physicians, nurses and members of the patient care team. Use the resources identified here to self-evaluate your EHR in order to identify and improve work processes and systems to prevent potential patient harm.


Learn more about CHC Information Technology services including technology assessment, the EHR and Meaningful Use incentives.

Tags: Electronic Health Record, Meaningful Use

CHC in the Spotlight