Automating certain tasks within the systems could be the key to settling EHR dissatisfaction.
As healthcare professionals attempt to navigate an increasingly data-driven, high-tech industry, some providers and patients remain skeptical that increased reliance on EHR systems is the right move.
EHRs have their advantages: several studies cite examples of the systems being key assets in efforts to improve preventive medicine, patient-provider communication, and positive drug interactions. Additionally, EHR systems offer patients increased transparency through patient portals providing a view of their own health information. However, not everyone is a fan of the technology. The question of whether EHR systems help or hurt the industry has driven a wedge between providers on either side of the argument. It’s no secret many providers are fed up with the arduous tasks inherent to inputting thorough documentation and entering new patient information into the systems.
Frustrated providers blame EHR systems for sucking the personal touch out of medicine and making many doctors feel like little more than data entry clerks. Increased reliance on health IT is also causing instances of patient harm. A recent study found health IT systems could be a contributing cause to medication errors resulting in significant patient safety threats. Researchers found 889 medication errors in provider reports submitted between January 1 and June 30 of 2016 cited health IT as a contributing cause for the listed error. Of these reported medication errors, the most frequently cited problems were dose omission, dosage errors, and extra doses.
“Errors due to HIT spanned across all HIT components, including the CPOE system, pharmacy system, electronic medication administration record (eMAR), clinical documentation system, clinical decision support system, ADC, and BCMA system,” stated researchers in the report. “There were many causes for HIT-related errors, and they were unique depending on the context in which the system was used.” However, these problems with health IT often arose from human error rather than problems with the technology itself. Distracted nurses and physicians entering incorrect information into EHR systems lead to prescription ordering errors and misinformation.
“Oftentimes, failures in the HIT systems are attributed to human error, which hinders the investigation into secondary causes of the patient safety event such as limitations in software interoperability, usability, and workflow processes,” researchers wrote. Researchers concluded offering nurses and physicians better training on how to use health IT and limiting distractions would decrease instances of human error. However, there could be an even more efficient way of cutting down on these patient safety issues: eliminating manual entry entirely.
The key to mitigating human error and shifting some of the burden of tedious data entry off providers’ shoulders could be an increased reliance on the very technology causing consternation among industry insiders. Specifically, Siemens Healthiness may have the right technology to minimize some of these problems. A new partnership between the solutions vendor and Relaymed delivers test results to physician EHR systems directly through point-of-care instruments. The secure, cloud-based service automatically delivers patient test results into physician EHR systems so providers don’t have to worry about manually entering the information themselves.
Designing technology capable of entering data into EHRs automatically removes the possibility for human error that often leads to additional costs and patient harm. This kind of automation also takes data entry off the provider’s plate, freeing up time for physicians to focus more on patient care. The technology could also increase hospital revenue — the service ensures all tests are saved into the physician EHR system to avoid accidental omission and lost revenue due to unbilled tests.
“We were finding our testing procedure to be time consuming and inefficient so we sought out a device connectivity solution,” said Senior Director of Operations and Compliance Officer for MD Medical Group Christy Vedia. “Since we implemented the service, we now have it live on 120 devices across 30 locations.” Limiting the need for manual data entry could also reduce physician burnout—a growing problem in the healthcare industry now being labeled as a public health crisis.
“The spike in reported burnout is directly attributable to loss of control over work, increased performance measurement (quality, cost, patient experience), the increasing complexity of medical care, the implementation of electronic health records (EHRs), and profound inefficiencies in the practice environment, all of which have altered work flows and patient interactions,” wrote healthcare CEOs in a post on Health Affairs Blog. “The high level of burnout among physicians should be considered an early warning sign of dysfunction in our health care system.” While CEOs in the post recommend improving EHR usability to limit the interruptions, frustrations, and distractions brought on by EHR technology, automation could be a more efficient way to limit how often providers are required to interact with their EHR systems.
Automation could also benefit clinicians through alerts built into EHR systems signaling when a provider is attempting to complete a task on the system that could pose a potential patient safety threat or result in unnecessary costs. A nationwide initiative to cut down on test ordering in hospitals recently gave rise to an automatic alert system in physician EHR systems with the potential to reduce instances of patient harm and save money. The Choosing Wisely campaign, launched by the American Board of Internal Medicine (ABIM) foundation and Consumer Reports in 2012, sought to reduce medical test ordering by prompting providers to cut back on five tests or procedures they deemed ineffectual. According to the National Academy of Medicine, over $200 billion a year is wasted on excessive medical testing and treatment. The organization also stated patient harm stemming from excessive medical testing and treatment accounts for 30,000 deaths a year.
Cedars-Sinai Medical Center in Los Angeles participated in the initiative and reduced test ordering through an alert built into the physician EHR workflow that automatically scanned 18 Choosing Wisely recommendations embedded into the software whenever doctors electronically ordered tests or drugs. In a study, Cedars-Sinai analyzed alerts from 26,424 patient encounters between 2013 and 2016. Six percent — 1,591 cases — followed all Choosing Wisely guidelines. Cedars-Sinai researchers found patients in groups that did not comply with Choosing Wisely guidelines had a 14 percent higher rate of readmission and a 29 percent higher risk of complications, increasing costs by 7 percent. In groups that did not comply with Choosing Wisely guidelines, patients had a 14 percent higher rate of readmission and a 29 percent higher risk of complications, increasing costs by 7 percent. After a year of implementing the electronic alert system, Cedars-Sinai saved 6 million in spending.
While this particular alert system was tailored specifically to Choosing Wisely recommendations, alerts aligned to other safety or cost-saving recommendations could be useful in automatically signaling providers to potential problems in the same way. Automating data entry and built-in alerts could be the tip of the iceberg. In theory, any rote task requiring manual input could be automated so physicians can shirk the more tedious responsibilities inherent to EHR systems while also mitigating problems arising from the technology. However, as with any relatively fresh undertaking, automation could be a slippery slope.
Automating too many tasks could increase the likelihood of a system malfunction affecting a larger portion of patient care. Additionally, increased reliance on EHR systems and technology could leave hospitals even more vulnerable in instances where hackers force healthcare organizations offline. Erie County Medical Center (ECMC) recently gave the healthcare industry an alarming glimpse into the repercussions of operating a technology-dependent hospital in the age of cyber crime. Hackers broke into the hospital’s network and forced ECMC back to paper records for over six weeks. ECMC was able to continue running somewhat smoothly with all staff members working diligently to keep up with incoming patients, but the ordeal served as a warning to other hospitals. EHR systems are by no means impervious and can be derailed by malevolent hackers at a moment’s notice.
Staying in the dark ages, however, is not the solution. Updating security measures along with developing technologies is an organization’s best bet when combating criminal activity. Increasing automation in EHR systems could change perceptions among patients and providers regarding the usefulness of the technology and reduce the administrative burden imposed on users. However, whether automating more daily clinical processes will mitigate or augment patient safety threats remains to be seen.
It will be up to innovators to find the line where too much automation and reliance on EHRs becomes a hindrance rather than a helping hand.