Unintended errors with EHR-based result management: a case series

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon 97239, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 01/2010; 17(1):104-7. DOI: 10.1197/jamia.M3294
Source: PubMed

ABSTRACT Test result management is an integral aspect of quality clinical care and a crucial part of the ambulatory medicine workflow. Correct and timely communication of results to a provider is the necessary first step in ambulatory result management and has been identified as a weakness in many paper-based systems. While electronic health records (EHRs) hold promise for improving the reliability of result management, the complexities involved make this a challenging task. Experience with test result management is reported, four new categories of result management errors identified are outlined, and solutions developed during a 2-year deployment of a commercial EHR are described. Recommendations for improving test result management with EHRs are then given.

Download full-text


Available from: Thomas R Yackel, Aug 23, 2015
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p=0.0001). Discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events.
    Journal of the American Medical Informatics Association 07/2010; 17(4):472-6. DOI:10.1136/jamia.2010.003335 · 3.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Researchers have conducted numerous case studies reporting the details on how laboratory test results of patients were missed by the ordering medical providers. Given the importance of timely test results in an outpatient setting, there is limited discussion of electronic versions of test result management tools to help clinicians and medical staff with this complex process. This paper presents three ideas to reduce missed results with a system that facilitates tracking laboratory tests from order to completion as well as during follow-up: (1) define a workflow management model that clarifies responsible agents and associated time frame, (2) generate a user interface for tracking that could eventually be integrated into current electronic health record (EHR) systems, (3) help identify common problems in past orders through retrospective analyses.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:1382-91.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Data captured in electronic medical records (EMRs) and paper charts have enormous potential for clinical research and to improve the quality of health care; however, accessing, organizing, and analyzing these data pose significant challenges. To address these challenges, this article reports development of a web-based application that provides for local clinical data capture as well as integration of patient data directly from an institutional EMR. A web-based system was created using an existing institutional application development framework. The application consists of a local clinical data repository, processes that integrate data from an EMR, and programs that enable end-user access, manual data capture, and analysis. Data are maintained in a relational database at the patient level in a time- oriented manner and by clinical data type. The application and data repository have been used to integrate and analyze a broad range of clinical data of 637 patients with burn injury. Research findings have shown that in addition to tracking clinical outcomes, laboratory data provide the ability to risk stratify patient populations to target high-risk individuals for case management and interventions. This effort validates the utility of web-based applications to collect local clinical data and integrate clinical data directly from an institutional EMR. This approach leverages institutionally collected clinical information and provides the flexibility to incorporate disparate data and accommodate system modifications as needed. Although the current efforts have focused on a cohort of patients with burn injury, the approach and system design are extendable to other patient types.
    Journal of burn care & research: official publication of the American Burn Association 09/2011; 32(6):654-9. DOI:10.1097/BCR.0b013e318231c55a · 1.55 Impact Factor
Show more