PRACTICE MANAGEMENT
Playing it SAFER EHR guides help frontline physicians
BY KARA NUZBACK Data- bases crash; backups fail. Sometimes, the very tools designed to help a practice operate smoothly from day to day can cause the big- gest disruption themselves. Are you and your staff doing everything you can to make sure your elec- tronic health record (EHR) system doesn’t botch pre- scription information or confuse one patient with another? If you’re not sure, a new toolkit can help you find out.
The Office of the Na- tional Coordinator for Health Information Tech- nology (ONC) released a free toolkit in January to help health care organiza- tions identify and mitigate patient safety risks associ- ated with EHRs. The Safety Assurance Factors for EHR Resilience (SAFER) guides are available at www.heal
thit.gov/safer/safer-guides. Houston internist Hard- eep Singh, MD, helped de- velop the guides, which he says can improve the quality and safety of EHRs in a real- world practice setting. Dr. Singh is a patient safety researcher at the Center for In- novations in Quality, Effectiveness and Safety at the Michael E. DeBakey Veterans Affairs Medical Center and an associate professor at Baylor College of Medicine. For the past five years, he has researched EHR-related patient safety risks, one of which involves clinician entry of inconsistent prescription information in the EHR system. If
a physician wants to pre- scribe warfarin, for exam- ple, the EHR’s order entry interface likely includes a drop-down menu to select the drug’s strength, com- monly 5 or 10 milligrams, Dr. Singh says.
While physicians select the dosage from an elec- tronic list of selections, they also may write free- text notes to clarify the dose, which can contradict the electronic selection. “This contradictory or- der introduces ambiguity,” he said.
An ambiguous prescrip- tion leaves pharmacists and patients confused and patients at risk.
Even without ambigu-
Houston internist Hardeep Singh, MD, helped develop the Safety Assurance Factors for EHR Resilience (SAFER) guides, which he says can improve the quality and safety of electronic health records in a real-world practice setting.
ity, a computer glitch or a typographical error could change a prescription from 3.0 milligrams to 30, or an EHR alert system could become an annoyance to a physician who begins to ignore the alerts and over- looks an important drug interaction notification.
Because EHR systems are new and continually evolving, Dr. Singh says, “introducing technology into health care is com- plex,” and health care professionals are just now beginning to understand new types of unintended consequences resulting from the use of EHRs. ONC sponsored the SAFER project to develop practical tools for practicing clinicians and hospitals. The tools allow physi- cians to close loopholes in the practice’s EHR system that could put patients at risk.
June 2014 TEXAS MEDICINE 35
MATT RAINWATERS
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