EHRs: beware autopilot errors

Special to Dermatology Times – Along with the advantages that electronic health records (EHRs) provide, experts say, comes the potential for errors often created by inattention.

"Sometimes, simple things work just fine," says Eliot Mostow, M.D., M.P.H. He is professor and chair of dermatology, Northeast Ohio Medical University, and associate clinical professor of dermatology, Case Western Reserve University School of Medicine.

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For example, says Dr. Mostow, an 8 x 11" checklist posted in exactly the right place can work wonders. Conversely, "Sometimes it's harder to do things on an EHR than to keep track of them on a simple paper."

With that in mind, he and Stephen Helms, M.D., offer the following EHR advice:

• Don't paste yourself into a corner. With EHRs, says Dr. Helms, the "copy and paste" function provides a popular shortcut for filling in required data fields. However, he cautions, overusing it can create inaccuracies. Not long ago, a hospital he worked with sent physicians an email about this problem. "They had patients who were comatose for three days, and for three days in a row their EHRs said 'Patient alert and oriented.' The Centers for Medicare & Medicaid services are looking closely" for such incongruities as healthcare reform advances. Dr. Helms is professor of dermatology at the University of Mississippi Medical Center. 
• Think outside the template. The structure of EHR templates and prompts can result in "closed" discussions, says Dr. Helms. When taking patient histories, for example, he suggests asking questions that go beyond the boxes provided rather than merely filling in the blanks.
• Keep records current. Dr. Helms finds it annoying that if someone doesn't record the discontinuation of drugs, the EMR will list everything the patient has ever taken as an active medication. "Sometimes something was prescribed for 10 days last year, and it's still showing up on the master medication list. You have to make sure whether that's current or not."
• Resist the temptation to ignore all EHR-generated warnings. Here, says Dr. Helms, "One of the problems is that whenever you prescribe something, a warning comes up. Statistics show that 85 percent or more of these are irrelevant. You get so used to just clicking through, it may be easy to miss the one that may be important."
• Take a team approach. In this regard, Dr. Helms says, "Have an assistant help with documentation – not just as a scribe, but in identifying the things they see repeatedly that we should do so that we become consistent."
• ​Communicate, communicate, communicate. When the design of an EHR creates a roadblock, says Dr. Mostow, "We need to work with the vendors and say, 'We're trying to do something pretty simple here. Help us think through better ways to do it.' Hopefully, by our sharing at meetings and other places, EHR companies will respond."

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Drs. Helms and Mostow report no relevant financial interests.

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