Sunday, January 2, 2011

Preventing electronic medical errors

Even though it happened several years ago, I still experience a visceral feeling of guilt and embarrassment when I recall the time I almost prescribed the wrong type of antibiotics for a patient's inner ear infection. As medical errors go, this would not have been that big a deal. Although the medication would have been completely useless for treating her infection, she wasn't likely to suffer serious side effects, or have her condition worsen from a delay in receiving appropriate treatment, since many inner ear infections resolve on their own.

What bothered me about this particular mistake was that I knew perfectly well that oral antibiotics—not eardrops—were the best choice and knew which one to prescribe, but had accidentally clicked on the wrong choice in my electronic medical record system, leading to the wrong prescription being printed. Fortunately, I was able to recognize this mistake before the patient left the office, hurriedly hand-write the correct prescription, and after apologizing, explain the reason for the switch.

My close call belies the widespread belief that the implementation of electronic medical record systems—which researchers recently reported are now used in slightly more than half of office-based practices—will naturally eliminate medical errors and make healthcare safer. Rather, these electronic systems only change the nature of the medical errors that are made. While they offer safeguards against accidental prescriptions of drugs patients are on record as being allergic to, and drugs that may not mix safely with others patients are taking, electronic health records are still vulnerable to incorrect entries, computer glitches, and unauthorized access of personal health information.

A group of studies by researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care identified five common sources of errors in family practices: medication prescribing, laboratory testing, misfiling of medical records, medication dispensing, and not responding promptly (or at all) to abnormal test results. The last type of error occurs distressingly often. In a retrospective audit of patient medical charts in 23 U.S. practices published last year in the journal Archives of Internal Medicine, Lawrence Casalino at Weil Cornell Medical College in New York and colleagues found that on average, one abnormal test result in 14 was never communicated to patients. Surprisingly, practices that used a "partial" electronic medical record (electronic progress notes but paper-based test reports, or vice versa) were nearly twice as likely to fail to notify patients as practices with no electronic records at all.

Indeed, electronic medical records are not failsafe. The Institute of Medicine recently formed a Committee on Patient Safety and Health Information Technology to better understand the potential risks they pose to patient safety. This committee, which met for the first time last week, plans to review the available evidence over the next year and make recommendations about the best ways for doctors and patients to prevent medical errors associated with electronic record use.

In the meantime, you are not powerless to become the victim of a medical mistake. There are strategies you can use to help your doctor keep you safe. The federal Agency for Healthcare Research and Quality has published a useful fact sheet entitled "20 Tips to Help Prevent Medical Errors." Many of these tips involve making sure you are well informed about any medicine your doctor prescribes, including knowing exactly why you need it, how frequently and for how long you should take it, what the likely side effects are, and what symptoms signal you should stop taking the medicine and contact your doctor for help. One more tip on that list I would definitely emphasize is: "If you have a test, don't assume that no news is good news—ask about the results." Actively working to improve communication with your doctor about your healthcare is the most effective way to avoid being harmed by a medical error. That's the bottom line.

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The above post was first published on my Healthcare Headaches blog at USNews.com.

2 comments:

  1. Thanks Kenny, I really enjoy your blog! When my daughter was an infant, she had a horrible cough and, since this was before they stopped recommending cough/cold medication for babies, her ped prescribed a syrup that contained codeine (I can't remember what the cough medication was). At the time, we went to the enormous Kaiser Permanente HMO in Los Angeles. The peds office had just finished switching over to a paperless system. I never did find out where the error happened, but THANK GOODNESS I obsessively research medications before giving them to my children, because somewhere between the exam room and the downstairs pharmacy, my tiny former preemie was given an adult-sized prescription. I was so scared I never gave her any. The most frustrating part was that I never got anywhere reporting it, no one seemed to even be alarmed. If I had given it to her, they would've had a massive malpractice suit on their hands!

    In L.A. I also always had to call for test results. Twice I was quite anemic (once during pregnancy) and never would've known if I hadn't pestered the office.

    Fortunately, my family has had excellent healthcare since returning to NC, and my care through Duke Health during a high-risk pregnancy was exemplary. Even so, I worry that people too easily forget that being computerized does not eliminate carelessness! Thanks for the reminder. :-)

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  2. You are right on with all of the points in this post. I always tell patients that my policy is that, "No news is no news." If you don't hear from me about a test I order, it means something wrong happened. Call or send a secure message and ask about the result.

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