New Electronic Health Records Proposed
November 8, 2012

Experts Propose New Framework For Electronic Health Records

Lee Rannals for — Your Universe Online

Experts have proposed a framework to help develop new national patient safety goals unique to electronic health record-enabled clinical settings.

The new electronic health records (EHRs) are expected to improve patient safety, but they can present challenges for which health care providers must be prepared.

"One of the reasons electronic health records were introduced was because we wanted to make health care safer, more efficient and of higher quality," Dr. Hardeep Singh, assistant professor of medicine and health services research at the Veterans Affairs Health Services Research, said in a statement.

"However, electronic health records present new hazards that were brought in with the use of technology and were not seen before. In this paper, we propose a framework that addresses three types of intersections between patient safety and electronic health records."

These intersections include making sure that the EHR technology is safe, the application and use of it is safe, and the technology is used to monitor and improve patient safety.

Similar to driving car, you must do checks before hitting the road and keep your hands on the steering wheel while your eyes are on the road to ensure safety.

"That's what we want from electronic health records," Dr. Dean Sittig, professor at the UT Health School of Biomedical Informatics, said in the statement.

The team proposes that goals should first address safety hazards unique to technology. The next phase would be to ensure goals mitigate safety hazards from failure to use technology appropriately.

In phase 3, the goals should stimulate the use of technology in order to monitor and improve patient safety.

Health care groups using electronic health records should start with phase 1, ensuring that the technology is safe to use, according to the researchers. This could include making sure the technology is fast enough to ensure acceptable system response time, and also that there is a data backup in the case of a loss of the data.

During phase 2, the groups should make sure that electronic health records are being used appropriately. Some organizations mix paper records and electronic records, resulting in not only extra work, but also confusion and risky scenarios.

"We suggest that organizations should use electronic health records "completely" rather than partially. It should be the only way to practice medicine in hospitals," Sittig said in the statement.

Some hospitals allow physicians on some units to use paper for orders, while other units require that orders be entered through electronic health records. Sittig suggests the technology be used consistently for the same purpose, rather than haphazardly.

The researchers also suggest in the new guidelines that organizations should address phase 3 to improve patient safety by better measurements.

They said the computer could monitor risky situations within a system and identify potential problems. In some cases, the computer could alert someone that there were abnormal lab results from last month that haven't been reviewed.

"You cannot reach high levels of patient safety without using the computer and without paying attention to the requirements of these three phases," they wrote in the New England Journal of Medicine.

Singh said that electronic health records are changing the way doctors practice medicine and deliver health care.

"Some of our recommendations are provided to ensure that you get the maximum benefits of EHRs," Singh said in a statement. "We want the EHR-enabled health system to be safer and far more effective than the paper-enabled health system."