Electronic Health Records Fail To Detect Up To 1 in 3 Harmful Drug Interactions And Other Medical Errors
by Marla Milling
How much faith do you put in the electronic health record (EHRs) at your doctor’s office or hospital that maintains your medical history and slate of prescriptions?
Those systems are designed to issue warnings if orders for a new medication could pose an allergic reaction, adverse drug interaction, excessive dose or other potentially harmful effects, but a new study reveals critical deficiencies in the accuracy.
Scientists at the University of Utah Health, Harvard University and Brigham and Women’s Hospital in Boston determined that EHRs consistently failed to detect errors that could injure or kill patients more than 30% of the time.
Study author David C. Classen, M.D., professor of internal medicine at U of U Health, says, “EHRs are supposed to ensure safe use of medications in hospitals. But they’re not doing that. In any other industry, this degree of software failure wouldn’t be tolerated,. You would never get on an airplane, for instance, if an airline could only promise it could get you to your destination safely two-thirds of the time.”
Classen says one snag is that while federal regulators inspect EHR systems with factory specifications, they don’t account for any alterations hospitals make after installation to meet their own needs.
He says, “This is a complex process that makes it difficult to keep up with all changes in drug safety. So, for example, a serious drug interaction that would trigger EHR warnings at one hospital might not at another one.”
To determine the effectiveness of EHRs in real-worth settings, the researchers studied the results of tests conducted by a safety evaluation tool called Leapfrog CPOE EHR test. This re-created real-life scenarios based on actual adverse drug events that harmed or killed patients.
One scenario focused on a 52-year-old woman admitted to a hospital with pneumonia. She was already taking a blood-thinning medication, Warfarin, once-a-day to combat deep vein thrombosis. At the hospital, she was given warfarin three times a day. The EHR system did not detect the excessive dosage for five days. The patient died as a direct result of the warfarin overdose.
They fed scenarios like this one into the EHR systems at more than 2,300 hospitals nationwide. All of the tests were conducted over a 10-year period from 2009 to 2018.
The results: in 2009, the systems correctly issued warnings or alerts 54% of the time. By 2018, there was only modest improvement with EHRs detecting about 66% of errors.
Study authors note that many hospitals don’t participate in such evaluations, so they surmise the true safety performance of U.S. hospitals could be worse that their study found.
The study appears in the May 29 issue of JAMA Network Open.