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Home > CDC on EHR errors: Enough's enough
CDC on EHR errors: Enough's enough
Posted on Jul 08, 2014
By Evan Schuman, Contributing Writer
The Centers for Disease Control and Prevention does not routinely get involved in telling
hospitals how to run operations, but with increasing reports of EHR deployment problems,
the Atlanta-based operation now sees the need to act.
"Some hospital laboratories have legacy information systems that do not even have the
ability to use current coding," said Megan Sawchuk, the lead health scientist for CDC's
office of public health scientific services, which is in the division of laboratory programs,
standards and services.
The problems, though, go way beyond outdated software. There are also issues involving
staff time and expertise. One key example is the huge number of codes and the
maddening fact that different medical facilities use different codes for the same tests. This
is particularly problematic for physicians who work in multiple hospitals and practices. "We
have to develop a simpler coding system that balances the clinician’s need to consistently
order the right test with the laboratory’s need to show unique aspects of testing when
necessary," Sawchuk said. "There are pros and cons on each side, but ultimately we want
to make it easy for clinicians to order and interpret the right test for the patient."
[See also: Object of beauty, or ungainly nuisance?]
Fixing this problem is critical, but the answer isn't obvious. Creating consistent codes will
require staff to make a lot of changes. "Staff need to have the time to learn and do the
coding. In small settings -- especially rural hospitals—they are very unlikely to have that
extra personnel," she said.
The CDC, which documented some of its concerns in a report issued in May, is finding
that many of the EHR hiccups are not only impacting patients, but have their roots in
system design. Specifically, the lack of IT participation in design details prior to rollout.
"End users are not yet sufficiently involved in the early stages of EHR design, including
innovation in display design and workflow analysis, and that creates problems with their
ability to effectively understand and use the information," Sawchuk said. She cited an
example that tied a display preference with a patient not being treated for a life-
threatening disease.
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2. Laboratory data is typically displayed in reverse chronological order, with the newest
results on top. One EHR had the default setting as chronological. This caused a patient to
have a critical delay in her care when her most recent and abnormal pap smear was
shown at the bottom of the list. The physician reviewing the historical results only looked
at the top of the list and assumed those were the most recent details. "Had a clinician
provided input during development of the system, or even during implementation, this
patient safety event could have been avoided," Sawchuk said.
Today there is no single place for heath IT issues such as this to be reported, including
“near misses,” Sawchuk argues, pointing to the best option being the Health IT Safety
Center proposed through FDASIA.
Sawchuk argues that such data centralization is needed because it's the only way to get
the data that is needed to fix the system. "At this point, many people have shared
anecdotes about safety concerns with their EHRs, but it is difficult to decipher the real
from perceived concerns, or even large-scale, systematic concerns from random, singular
concerns," she said. "Until aggregated, credible data is available, it will be a challenge for
all stakeholders to prioritize their resources to address the most important concerns."
[See also: 5 health IT insiders offer their takes on EHR usability.]
The CDC's position makes sense. The problem looks deceptively easy to resolve given
widespread agreement that naming and preference standardization is needed. The
answer lies is getting hospitals to agree on the consistent format and that funding
everyone using anything else to make a huge number of changes. The fact that this
should have to be done only once is of little consolation to short-staffed hospital
administrators who have no resources to make such changes.
In short, agreeing that a change is needed is not the same as having the
wherewithal—meaning money—to do the work to change it. Unfortunately, making this
optional—or on a "when you have the time" schedule—is no longer viable.
Source URL: http://www.healthcareitnews.com/news/cdc-ehr-errors-enoughs-enough
Page 2 of 2CDC on EHR errors: Enough's enough
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