"alarm fatigue Design ECRI EHR fda"

The dangerous side effects of EHRs

Originally posted 8-12-2010:
Technology has allowed healthcare to make leaps and bounds in patient care.  It has helped solve many problems for health care professionals in treating their patients.  After years of working in healthcare, I have learned that introducing new technology has side effects and can introduce dangerous problems into the system.  A recent article in this month's Health Data Management drives this point home.

The article focuses on the types of problems that EHRs can introduce into the healthcare environment, many of which can lead to potentially dangerous situations for the patients the system is trying to protect.  This quote from David Bates in the article sums it up well: "Your EHR may prevent 10 errors for every new one it causes..."  One of the main problems is the overriding of alarms due to alert fatigue. A lack of alert standardization also is part of the reason why "eighty to 90 percent of alerts are overridden."  Other dangerous issues mentioned include entering data for the wrong patient with too many windows opened on the screen and look alike drugs on the display. The article also points out "problems with computerized systems" was ranked 7th on the ECRI Institute's top 10 list of technology hazards in healthcare.

The article states a few reasons behind why these issues are occurring with EHRs.  The one that stuck out most to me was "software design, or lack of it, is a common culprit".  That is a tough one to swallow from where I sit.  Unfortunately, I have had heard many remarks from healthcare professionals about software they find tedious to use.  Even on my recent vacation a lab worker overhearing me explaining my job, spoke very negatively about an EHR system she used to work with.  I have mentioned it a few times now, but it is very important for the IT vendors to really know their users when designing their products.  Understanding workflows and working closely with end users at implementation will lead to smooth transition with the use of the new system.  There is so much information to digest, there is no need to make it any harder for the care givers to work with the technology. Software design is not the only issue, but good design is one of the steps to make these systems safer for the patients.

One final item from the article worth mentioning is the lack of healthcare IT standardization.  The article finishes with some discussion on the advantages and disadvantages of the FDA regulating EHRs.  In my opinion, I do believe there needs to be some standardization to promote patient safety in these products.  I understand regulations can bring a lot of red tape, but setting up some standards can improve the safety and quality of these products.  It has been there for medical devices, why shouldn't it be there for medical records and decision support tools?

I'm curious to know if any of you have run into situation with an EHR that could have led to a dangerous situation.