What we don’t hear: the risks associated with EDIS

“Electronic health records, including EDISs, should be designed to match common properties of human perception and decisionmaking, as well as task- and use-specific properties of work.” – Farley et al.

The Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians recently published an article in the Annals of Emergency Medicine about the benefits and drawbacks of EDISs (Emergency Department Information Systems).  The article was interesting, because not only did it point out the potential benefits of EDISs – such as increasing legibility of notes, decreasing dosing errors, and identifying potential drug interactions – it also identified the potential drawbacks of an EDIS that is not well thought out.

The drawbacks of EDISs

The article identified four potential scenarios where an EDIS might have an adverse impact on patient care:

1. Communication failures because of an over reliance on the system, replacing personal interactions
2. Errors because of poor data display
3. Order errors because of poor in-EDIS patient management
4. Medical errors, where best-practice alerts are accidentally ignored because of poor EDIS usability

Most importantly, the article identifies these errors as being the result of “poor human-computer interactions” that lead to an increased likelihood of medical errors.

Avoiding negative EDIS implications

Although there are potential drawbacks, the potential benefits of a well-functioning EDIS are too important to ignore.  The article makes seven recommendations aout how to improve the safety of these systems, but they can be summarized in two broad categories.

1. Ensure you have full participation and buy-in when choosing and designing your EDIS

We’ve previously written about how to achieve full buy-in, but the article reinforces the importance of minimizing errors due to poor human-computer interactions.  If users are comfortable with the system, they are more likely to benefit from its use (and suffer due to its misuse).

2. Built an EDIS that fits your workflow instead of changing workflow to fit your computer system

This is the most important conclusion of the article.  The errors identified were almost exclusively because doctors had to modify how they work to accommodate their EDIS.  Instead, a well-designed EDIS should complement the skills of nurses and doctors.

Conclusion

Electronic health records and EDISs have arrived and are here to stay; the potential improvements to patient safety and care make them impossible to ignore.  However, hospitals must be judicious about what and how they implement.

If emergency medicine practitioners must strain to accommodate new computer systems, errors will occur.  Instead, hospitals that seek to maximize patient safety (and, not coincidentally, physician satisfaction), should choose EDIS solutions that work for and with nurses and doctors.