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Electronic Health Records Problems

photo doctor using tablet - pros and cons of electronic health recordsWe’re all accustomed to seeing our doctors use their computer or tablet during appointments and in the hospital since electronic health records (EHRs) are widely used. Is this a good development? Is the information in EHRs accurate? Do EHRs add to doctor stress, potentially impacting care? Although there are clear advantages of EHRs, there are also common electronic health records problems. And what can we do to reduce our risk of potential harm?

The pros.

There are many positive aspects of EHRs including a potential for improved accuracy, the potential for patients to access their records through a web portal, and easier identification of potential adverse interactions between medications. However, there are significant, potentially dangerous issues as well.

Electronic health records problems – safety issues.

It’s impossible for doctors to provide proper care if they don’t have the correct information. According to a Kaiser Health News and Fortune Magazine investigation, EHRs have created a host of largely unacknowledged patient safety risks. They found thousands of cases of patient deaths, serious injuries and near misses related to software glitches, user errors or other flaws. And the information about these injuries remain largely unseen in various government-funded and private repositories.

Accuracy issues.

It goes without saying that patients want the information in their medical records to be accurate. How can your doctor** treat you properly if your medical records contain mistakes about your history, symptoms, medications and/or diagnoses? But EHRs can contain mistakes.

Data mistakes.

photo blackboard sign about technical issues - the pros and cons of electronic health recordsOf course, all people make mistakes, including doctors and other medical professionals. However, there are a few issues related to EHRs that increase the likelihood of record errors since the interface is often clumsy and unintuitive. And sometimes the design of the EHR is responsible for data mistakes. Some of the potential data errors include:

Technical issues.

Many EHRs are confusing and not at all user-friendly, making it hard for doctors to navigate the system and correctly add data.

Furthermore, MedStar Health National Center for Human Factors in Healthcare examined EHR data and found that 39.5% of the EHRs they evaluated had a technical issue that could potentially harm patients. For instance, one EHR removed the decimal point when medication doses were entered, so a 2.5 milligram order would be processed by the EHR as 25 milligrams. This type of technical issue has the potential to cause a dangerous drug overdose.

Auto-correct and auto-complete issues.

photo of OOPS written on yellow note - pros and cons of electronic health recordsMany EHRs use auto-complete software, which automatically fills in text for doctors after typing a few letters, making it very easy for your doctor to accidentally enter wrong information. Additionally, the auto-correct function can cause mistakes. Auto-correct identifies and corrects spelling errors, but it can also change words to other, similar words that can impact the patient’s diagnosis and care.

Information electronically misplaced.

Unfortunately, it’s relatively easy for information about one patient to be accidentally recorded in another patient’s EHR.

How common are mistakes?

Although more research is needed, one expert estimates that “about 70 percent of patient records have wrong information“.

The results of a 2017 survey, with almost 30,000 responses, found that 20% of patients who read their online medical record notes found a mistake. Moreover, 40% of respondents considered the mistake serious. The errors that respondents considered very serious included:

  • Mistakes in diagnosis.
  • Errors in medical history, physical exam and/or test results.
  • Notes belonging to another patient.

A 2017 article on research in a large ophthalmology clinic found that symptoms listed by the patient on their intake questionnaire were often not included in their EHR. Symptoms that never made it into the patient’s EHRs:

  • 33.8% of patients’ blurred vision
  • 48.1% of glare issues
  • 26.5% of reports of pain/discomfort

The mistake that keeps on giving.

When doctors and other medical professionals make mistakes entering information, including mistakes regarding diagnosis, tests, and medications, this misinformation will travel with the patient if corrections aren’t made. And this can be a frustrating, and dangerous, problem.

Complicated interfaces can lead to missed information.

There is a lot of information available on each patient, with many different screens for doctors to navigate. Time constraints, particularly in the ER, can make it hard, if not impossible, for doctors to see all the medical information needed to safely treat patients. This can lead to missed test results, missed allergy alerts and other safety-related mistakes.

EHR-related medication issues.

photo of female patient in hospital taking a pill - pros and cons of electronic health recordsEHRs can lead to serious medication issues, including patients receiving the wrong medication, the wrong doses (including overdoses) and treatment delays.

First of all, researchers found that the EHRs don’t always contain accurate, up-to-date information about medications. In fact, based on doctors’ clinical notes, almost 25% of medications were missing or incorrect in the EHR medication lists. These discrepancies can cause serious health problems, include adverse drug interactions, because each doctor on a patient’s medical team doesn’t have access to an accurate list of medications.

Additionally, EHRs can lead to a slew of other medication safety issues as well. Researchers for the Pew Charitable Trusts identified 12 ways in which EHRs can lead to medication safety issues in hospitals, which can cause serious treatment mistakes and subsequent health problems. And this is a particularly serious issue for pediatric patients, who often have the doses of their medications based on their weights and/or ages. Although this research focused on pediatrics, it is clear that these issues could impact patients of all ages.

What are the Pew Charitable Trusts potential medication safety issues in hospitals?

Below find summaries for 9 of their 12 medication safety issues. For more detailed information on all 12 issues, read the report.

  1. photo nurse filling syringeIf a doctor enters information in a field that isn’t visible to a nurse, medication errors can occur.
  2. The dosage for pediatric patients is often based on the patient’s weight. But if staff use the wrong units to enter the weight (kilos vs pounds), dosage errors occur.
  3. Poorly designed information displays, including a failure to show an upcoming dosage, can lead to missed medications.
  4. When patients relocate within the hospital, staff must remember to remove an automatic medication hold. If the hold isn’t removed, doses can be missed.
  5. EHRs can have built-in processes, with automated medication schedules, that doctors cannot override, leading to medication errors.
  6. Doctors can order recurring doses of medication at specific times or intervals. But system defaults can override these instructions without staff realizing it, causing patients to get medications at the wrong time.
  7. EHRs may have hidden preset medication order settings that calculate the quantities of drugs needed. But these preset choices can cause the patient to receive the wrong amount of medication.
  8. EHRs are designed to protect patients from allergic reactions and adverse drug interactions. When doctors order new medications, EHRs should warn doctors about potential dangers. However, in certain circumstances, this warning system can fail, potentially causing serious harm.
  9. Although EHRs can classify medications as needed for an indefinite amount of time or for a specified period, doctors cannot always clearly distinguish between these two types of orders in some EHR interfaces. This can lead to the automatic discontinuation of a needed medication.

EHRs don’t talk to each other.

In 2009 when President Obama present his initiative to digitize medical records, one goal was to improve record sharing between doctors and hospitals. But that hasn’t happened. Instead, the thousands of EHRs used in the US “largely remain a sprawling, disconnected patchwork“. Since EHR systems, developed by over 700 vendors, routinely don’t communicate with each other, doctors must transfer medical information with old fashioned faxes and CD-ROMs. ­

EHRs increase doctors’ stress levels.

It’s tough to be a doctor. It’s a lot of responsibility. There’s so much information to learn and retain. And payment pressures often require doctors to set time-squeezed appointments. However, a major cause of stress for doctors today is EHRs. Doctors spend hours every day on EHRs – often more time than they spend with patients. Why and how? Read this post to learn more.

So, what can you do about electronic health records problems?

Fortunately, there are steps you can take to reduce our risk of issues related to EHRs.

Make sure your doctor is correctly hearing, and recording, your issues.  

photo doctor at desk speaking the patientIt is crucial that your doctor correctly hears what you are saying and accurately enters the information into the computer. Many doctors, including most of mine, say the words as they type, allowing patients to speak up if they hear something that is not accurate. During your appointment, if your doctor says something incorrect or confusing about your history, symptoms and/or your medications, speak up right away!  Don’t be afraid to politely interrupt.

Additionally, you might find it helpful to ask the doctor to share the computer screen with you, allowing you to see what the doctor is typing. Don’t be afraid to ask. These are your medical records after all!

Finally, if you are discussing something you consider critical, or sensitive, and you would like the doctor to look at you instead of the screen, say so.

Take charge of your medical information.

Make sure your EHR is accurate. Ask your doctor to print a copy of each appointment’s notes and read through the notes at the doctor’s office or at home. Notify your doctor as soon as possible if you see something wrong. Read my post Are Your Medical Records Accurate? to learn more about accuracy issues and how you can address problems in your records.

Importantly, don’t rely on your EHR to be the master of your information. Since mistakes can occur, keep your important medical records together and organized, including test results, medications prescribed and clinical trial information. Bring your records with you to all medical appointments, including visits to the ER.

Do you need copies of your medical records? For more information, read Tips for Getting Copies of Your Medical Records.

Take detailed notes at all appointments.

photo of hand writing in notebookSince your doctor’s notes may be inaccurate or incomplete, and not always shared between doctors, you must take detailed notes, while still with the doctor, at every medical appointment – don’t even wait until you get in the car! A landmark study found that 40-80% of medical information provided by healthcare professionals is forgotten immediately; the more information presented, the lower the proportion remembered. Of the information patients remembered, they incorrectly remembered almost 50%.

Take notes by hand, not on your phone, tablet or laptop. Writing (versus typing) helps you remember and understand information. A recent study on note-taking by college students found those who took handwritten notes remembered the material better, and were able to synthesize the information better, than students who used a laptop. It’s hard to say if this translates into note taking in a doctor’s office, but these findings could apply. Writing also helps you maintain eye contact with the doctor which can improve the quality of the appointment. Lastly, if you use a tablet or phone, auto-correct may dramatically change important words, leaving you guessing. If you want to keep digital notes, type your handwritten notes at home. Either way, bring your notes with you to every appointment.

Reduce your risk of medication errors.

Always carry a detailed, accurate list of medications with you. When at a doctor’s office, check your list against your EHR list (which you should receive when you check in). If you notice a discrepancy, be sure to tell your doctor. If you or a loved one is hospitalized, keep the medication list bedside and make sure every medication presented is correct. And perhaps most importantly, if something doesn’t seem right, speak up!

Read my posts for more information on reducing your risk of medication errors:

**Although nurse practitioners and other health professionals use EHRs and prescribe medications, for ease of reading, “doctor” refers to all medical professionals.

Note: I updated this post on 1-15-20.

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