Vol. 11 Issue 8
Safeguarding Patients with Electronic Medical Records
Using Technology To Direct Care
For many years, members of the health care community viewed electronic medical records (EMRs) as a technology that could cut administrative costs by eliminating paper and improving health care delivery processes. In light of the Health Insurance Portability and Accountability Act, now is a good time to examine the EMR's role in safeguarding patient information.
By using the EMR as a driving force behind complete electronic patient management, the technology can work as a tool to significantly improve patient safety and then some. Considering that the Institute of Medicine recently reported that an unwarranted number of patients die annually due to medical errors, health care professionals need to start considering EMRs as essential technology. This article outlines specific areas in which EMRs improve patient safety.
When deployed as part of an electronic patient management initiative, EMRs are capable of easing a plethora of patient safety issues. The most obvious and frequently cited way that an EMR can increase patient safety is by detecting potential medication errors. An EMR can successfully ward off three types of medication errors:
• Drug-drug interactions. An electronic system can warn providers when they are about to prescribe a drug that has potentially dangerous interactions with another medication.
To detect drug interactions with a paper-based record, a prescriber would need to thoroughly review the chart to see the patient's current medications and then mentally cross-reference those drugs with any knowledge of potential interactions. Alternatively, by using an EMR, the prescriber could take the time to consult a reference to determine if there are any potentially dangerous interactions with the patient's medications.
In addition, the prescriber would have to trust that the paper chart contained complete information about the patient's medications. If not, he or she would face the task of asking the patient to list current prescriptions a process that is likely to take considerable time and effort.
• Patient allergy interactions. An EMR can also automatically alert the provider to patients' drug allergies. Providers often have to take time to locate patient allergy information in a paper chart or to ask patients to recall allergy information. Keep in mind that patients typically misidentify drugs. In addition, patients, especially those who are experiencing some sort of trauma, might not recall their drug allergies. That's where an EMR can be useful, immediately alerting prescribers about potential drug allergies.
• Patient condition interactions. With some conditions, such as glaucoma and diabetes, specific drugs present significant danger to patients. By using an EMR, the provider would not have to review the complete patient chart before prescribing for those conditions. Instead, a specialist would access the electronic record to review a patient's overall condition.
For example, if a dermatologic NP, oncologist and pediatric NP all worked from the same EMR, it would be much easier to keep up with a patient's complete medical history. As such, if a provider were prescribing a medication for an acute condition such as a skin rash, any potentially dangerous interaction due to a patient's chronic condition would automatically pop up.
The Correct Medications
Eliminating dangerous drug interactions is just the first step in increasing patient safety. EMRs also can ensure that patients receive the correct medications. In some instances, the patient may not be at risk for a dangerous interaction but might not be taking the correct medications.
Consider the following scenario: A provider utilizing an EMR saw another provider's patient for a routine visit. The provider noticed that the patient had colitis but was not taking the correct dosage of medication. The provider notified the patient's gastrointestinal specialist, changed the dosage on his prescription and also printed out an educational article about colitis. Without the EMR, the provider would not have known about the man's condition, would not have been able to change the prescription and would not have been able to alert the specialist. The provider also entered a note in the EMR to follow up on the case in 1 month. Without this intervention, the patient could have developed a number of problems, including cancer or chronic bowel syndrome.
While many dangerous errors can occur in the hospital, patients face even greater risk when they leave a health care facility. Some patients take dozens of medications. Remembering each medication schedule can become overwhelming for patients, especially those affected by serious illness.
Although written instructions might be available in a paper-based system, such instructions are likely to correspond to individual treatments, leaving the patient with the confusing task of integrating all the information.
So, instead of merely giving patients verbal instructions or disjointed written materials, an EMR can print out thorough, integrated instructions detailing when, where and how medications should be administered.
Providing such user-friendly guides generated from an EMR makes it easier for patients to comply with complicated medication regimens.
Continuity of Care
Because of insurance changes and the mobility of our population, many patients frequently switch primary care providers. In addition, many patients see a bevy of specialists for various conditions. As a result, providers frequently have access to only a portion of the patient's medical record. Plus, most providers don't know an entire family from generation to generation, as many did in the past.
With a properly administered and shared EMR, providers have access to a patient's complete medical history, making it possible to avoid misdiagnoses or mistakes due to incomplete information
Continuity of care comes into play in emergency scenarios as well. For example, a patient could see a provider in the morning and then arrive in the emergency department that same night. The patient might not remember why he saw the provider in the morning. With an EMR, the emergency department provider could pull up the record and easily access all recent patient notes and lab results.
As a result, the provider could assess the patient's presenting condition in context of the totality of the patient's condition. By doing so, the provider would make a better decision without compromising the patient's safety.
An Ounce of Prevention
Having access to the right information can also prevent a number of lethal illnesses. An EMR allows the provider to determine if a patient has a familial risk for specific diseases such as colon, skin or breast cancer. Armed with such information, the provider could start screening and testing the patient accordingly – thereby reducing the risk of developing advanced-stage cancer.
In addition, providers would be able to track immunizations to prevent disease. With an EMR, providers can easily see which immunizations a patient needs and which ones have been administered.
With a paper record, providers basically have to remember when patients needed immunizations and then scour the paper records to see if the immunizations have been administered.
EMRs can improve the patient experience by notifying patients of drug recalls. When the FDA or other regulatory agencies recall a drug, providers who use a paper record usually have to hope that their patients hear about the drug recall and come in for an alternate prescription. It would be virtually impossible for the office staff to scan all paper records, identify which patients are taking the recalled medication and then notify each of those patients.
With an EMR, the process is fairly simple. A simple computer interaction typically identifies which patients are taking the recalled drug. Notifying patients is easy as well: Practice staff could draft one letter and perform a mail merge. Within a couple of hours, letters could be in the mail to all patients taking the recalled drug.
Also, consider that evaluating provider performance requires outcomes data, which can be difficult to aggregate into meaningful information using a paper record. The best way to acquire that data is via an EMR. An EMR can check to make sure providers are utilizing certain "best practices" and performing within desired outcomes ranges. As a result, patients can find out if they are seeing a provider who has the proven ability to treat their specific conditions.
Implementing an EMR is the first step toward improving patient safety. But for the technology to have a significant impact, health care professionals need to change their mindsets. We need to stop thinking of the EMR as an administrative tool and think of it as part of a complete electronic medical management program. Becoming "paperless" in a medical office is a byproduct, not the end-point. The goal should be complete electronic patient management.
Today's administrative and clinical professionals need to stretch their conception of EMRs by asking:
• How can the EMR be used to change and improve provider behavior?
• How can this tool be used to improve communication among providers?
• How can this tool help providers monitor themselves?
Health care professionals can begin to lay the groundwork for a comprehensive electronic medical management system that protects patient safety and:
• establishes a national standard of care or a best practice, which confronts a provider every time he or she sees the patient, regardless of care setting
• establishes a methodology for auditing the provider's compliance with best practices
• enables a methodology to adapt dynamically to changes in those best practices
• creates an environment in which the provider is a partner in the care process and not the victim of it (either legally or administratively).
To provide comprehensive medical management, health care providers need to choose an EMR with full clinical functionality.
Although EMRs have been around for many years, the call to embrace full-featured clinical systems is more relevant and possible today. The financial justification makes a lot of sense, but the life-and-death claim carries even more urgency. Implementing electronic medical records software as part of a complete electronic patient management program can significantly improve patient safety and ultimately save lives.
James Holly, a physician, is the chief executive officer and managing partner of Southeast Texas Medical Associates in Beaumont, Texas.
Going Cold Turkey From Paper to Electronic
Human nature is to ease into change. But when it comes to moving from paper to electronic medical records (EMR), the best practice is to go "cold turkey." In other words, starting with your go-live date, establish a best practice policy of "all electronic records all the time." This does not include switching back and forth from the electronic record to the paper record. Nor does it allow for printing from the electronic record to perform record review or patient care.
While this may seem overwhelming at first, the benefits greatly outweigh the initial pain of immediate change. Your office will quickly become efficient by immediately replacing manual processes, and you will rapidly save money by eliminating paper and other supplies.
In addition, having a strict policy of using only the EMR will avoid duplicating records and efforts. Maintaining and allowing access to both a paper record and the electronic record which becomes the permanent legal medical record as part of normal business practices is problematic for several reasons. First, having both types of records makes it difficult to comply with regulations such as the disclosure requirements of the Health Insurance Portability and Accountability Act (HIPAA). Second, there's too great an opportunity for paper to be modified and then not incorporated into the new legal medical record. Finally, it's more difficult to support confidentiality practices and guard against unauthorized use of patient information when two types of records exist.
To help your staff immediately replace paper records with EMR, commit to the following three key success factors:
• Scan and index the patient record within 24 hours after discharge.
• Make the electronic chart available to all users.
• Be sure to have an adequate number of computer workstations available throughout the facility.
While best practices for an EMR include storing the paper record for a certain period of time, paper is best thought of as "out of sight, out of mind." With an "all electronic records all the time" approach, all users of the patient chart will realize the benefits of convenience, multiple-user access and streamlined patient care.
Joseph Bailey and Marybeth Besosa are application consultants for McKesson Information Solutions' Enterprise Imaging Group in Alpharetta, Ga.