Bottlenecks
of
Electronic
Documentation
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Clinical
The Office of the National Coordinator for Health Information Technology estimates that the percentage of U.S. doctor’s offices with digital record system has gone up to 48 percent from 17 during 2008-2013, while the percentage of American hospitals with digital record system increased to 70 percent from 13 during the same period. Though the electronic system has its advantages, health experts find several bottlenecks with electronic clinical documentation. In their opinion, though the Obama administration is pushing for digital record system, poorly managed EHRs are causing a number of mishaps, even patient deaths.
Adverse Effects of EHRs Many health experts do advocate abandoning traditional paper charts and embracing digital technology. They are of the opinion that wide use of bar-coding, matching patient wristbands with the drugs they are provided create a safe environment. However, rushing to implement EHR with a view to getting subsidies without making enough preparations has resulted in complex and error-prone computer systems in highly sensitive clinical settings. The adverse effects of such digital health record systems are as follows.
Medication Errors – This type of errors may happen when medication dosage is entered incorrectly or when the patient’s health condition is wrongly specified or missed out. The Boston Globe reports how insulin overdose due to the error related to computerized medical records led to the death of a visual artist who suffered from diabetes, congestive heart failure, and other serious health problems. The report also cites an incident in which the history of an aneurysm was missing from a patient’s medical record while converting paper files to digital. The aneurysm burst and that patient died during a subsequent procedure as the physician did not know about this history. Medication errors can seriously harm the patient’s health condition and it is very important to eliminate these errors.
Malpractice Claims – The safety researchers for a Harvard-affiliated malpractice insurance group, CRICO published a study on malpractice claims this year and it revealed that 5,700 malpractice claims were filed during 2012-2013. The study also says that incorrect information within EHRs was the cause for 147 cases out of this. The errors included incorrect data entry (60 inches recorded as 60 centimeters), unexpected conversions (2.5 changed to 25), wrong file or field selection and repeated mistakes. EHR-related problems with the claims represented $61 million in direct payments and legal expenses. It was also found that half of patients affected by these errors were designated as serious.
Major Causes of EHR Errors Hybrid Records/Conversion Issues – This type of problem occurs when the information within paper and electronic records are inconsistent, mostly during the transition to EHR.
The status of a patient will be misinterpreted due to this. The
insulin overdose informed in The Boston Globe report was caused by this issue. The nurses were acting according to the multiple orders for insulin entered into two separate systems in the hospital – one digital and the other involving paper and a fax. This vulnerability was found to be a contributing factor in 16% of the CRICO cases as well.
Copy - Pasting – Physicians used to copy and paste information within EHR templates to balance their time between documentation and patient care and thereby increase the productivity. However, improper use of copy-paste function without updating daily notes on patients increases the chance of duplication. If your EHR system is integrated with other systems, a simple copy-paste error can make the matter worse as it will be reflected on related documents quickly and it becomes quite difficult to understand where the actual error occurred.
System Failure – Technological problems also contribute to the errors within digital records. These problems include routing failures (for example, unable to send test results to the hospital unit where the patient is located), computers that go down and inability to access data. Well-designed computer systems can help improve patient care. Routing failures form 12% of CRICO cases, whereas accessibility issues form 10% and design failures form 9% of cases. Pre-filled
forms
and
point-to-click
EHR
templates
can
cause
incomplete
documentation as physicians find limited number of choices.
Effective Solutions
Barcode EMR System
A study by researchers at Boston-based Brigham and Women’s hospital found that when medications were ordered and administered with a barcode electronic medication administration system, the errors as well as adverse effects were reduced. During the study, the researchers examined the effect of a barcode-enabled medication administration linked up with patients' personal EHR files. Around 3,082 order transcriptions and 14,041 medication administrations that occurred before and after barcode EMR system implementation were observed. It was found that 776 non-timing errors (mistakes unrelated to the early or late administration of the drugs) occurred in the case of medications that were not ordered and administered through the barcode system. The use of the barcode EMR system resulted only in 495 non-timing errors which signify a 41.4 percent decrease in errors. The adverse events that were 3.1 percent without barcode EMR reduced to 1.6 percent with barcode EMR (50.8 percent reduction). Barcode system did not cause any transcription errors unlike its counterpart with an error rate of 6.1 percent.
Healthcare experts suggest that barcode system can greatly improve patient care levels. Moreover, the Centers for Medicare and Medicaid Services has included barcoding as a requirement for the second stage of meaningful use. However, a successful bar-coding system incorporates information from various departments in a hospital and therefore effective communication and collaboration is essential to adopt a fully-functioning policy. Experts say though collaboration is important, the more crucial thing in adopting a barcode system is clear direction from a project manager.
Integrating EHR and Transcription
Combining Electronic Health Record system and transcription is a good approach to eliminate errors with digital records and associated adverse events. In this approach, trained and experienced medical transcriptionists will capture physicians’ dictation and transcribe them into accurate documents. The transcribed content thus obtained can be populated into the appropriate fields within EMR using discrete reportable transcription (DRT). This will reduce data entry costs and relieve physicians from involving in complex data entry tasks. Due to this, there is less chance for copypaste errors and duplication. EMR drop-down boxes and templates are not that good for recording meaningful conversation. On the other hand, narratives can be documented clearly through transcription and made more meaningful by integrating with EMR. Professional medical transcription companies that offer feeds to EMR system will have multi-level checks involving editors and proofreaders, which will further improve the accuracy of information within digital records.
Contact MTS Transcription Services at 1-800-670-2809 or mail us at info@managedoutsource.com