An electronic medical record (EMR) system can be a tremendously valuable tool. When used effectively, EMRs can help streamline workflow, enhance accuracy of diagnosis and treatment, reduce data entry errors, boost productivity, strengthen data privacy and security, and much more. On a broader scale, these benefits can help improve the overall quality of care delivered by an organization.
While use of EMRs can prove beneficial, these systems are not without their faults. In fact, EMR limitations and shortcomings have the potential to reduce care quality and even threaten safety. Here are four areas where EMRs can fail to meet needs and expectations.
Assuming it was entered correctly, the data stored in an EMR provides organizations with reliable snapshots about patients. Unfortunately, these snapshots often paint incomplete pictures.
The reason: EMRs often struggle with interoperability. When patient data is entered into systems that are unable to communicate with the EMR, the medical record in the EMR is now missing that data. This information could supplement existing information or include details that should replace now outdated data in the EMR.
Some common blind spots include medications, allergies, labs, and problem lists. Further compounding this challenge: With the surge of acquisitions and consolidations in healthcare, some health systems are now using multiple types of EMRs within the same organization. Until development of interoperability bridges between the technologies, a single health system could have incomplete patient data stored across its facilities. At a time when there is increased focus on improving care coordination and reducing redundancy, inadequate interoperability threatens both.
Pro: EMRs can provide real-time safety alerts about serious matters such as drug-allergy, drug-drug, and drug-disease risks during the physician order entry process. Con: Clinicians can receive numerous alerts, most of which are in inconsequential. This can potentially lead to "alert fatigue."
When alert fatigue occurs, physicians become desensitized to the safety alerts and develop a natural tendency to ignore or miss warnings. When this occurs for the occasional, meaningful warning, patient safety is put at risk.
A patient safety primer report from the Agency for Healthcare Research and Quality references a study that found physiologic monitors in an academic hospital's 66 adult intensive care unit beds generated more than 2 million alerts in one month. This translates to 187 warnings per patient per day. And according to another references study, computer physician order entry process systems generate warnings for 3%–6% of all orders entered, meaning a physician could receive dozens of warnings each day.
Some EMRs now include embedded direct email or text messaging systems. Unfortunately, they often lack sophistication, with these systems performing more like secondary add-ons rather than primary components that received careful attention to design and functionality.
Rather than improve communications, reliance on such systems can potentially compound safety issues when communications result in unclear or incomplete information. Poor communication can have a significant effect on care quality. In fact, a 2015 report from CRICO Strategies found that nearly one-third of national medical malpractice complaints involve some form of communication failure.
4. Patient Interaction
As reliance on technology like EMRs has grown, there is often less personal interaction between physicians and patients. Clinicians now spend much of their time staring at screens, navigating through often non-intuitive systems, and moving as quickly as possible to fill out the numerous fields required for a complete medical record. This data entry often occurs with the clinician's back to the patient in the room. Questions of patients are frequently asked over the clinician's shoulder or with very limited eye contact.
During such interactions, the patient experience can be compromised. Patients may feel overwhelmed by the manner and sheer number of questions asked. The lack of face-to-face interaction can give patients the impression that they are nothing more than a number and diagnosis. If patients become frustrated with this experience, they may omit important information because of a desire to end the interaction quickly.
Systems designed without user-friendliness in mind can also harm the physician experience. If clinicians are expected to spend most of their time with patients performing data entry, this increases the potential for missing patient body language that could indicate confusion about information requested or hesitation to share important personal details.
As a report from the American Academy of Family Physicians notes, the highly regarded Institute of Medicine report "To Err is Human: Building a Safer Health System" identified poor doctor-patient communication as one of the root causes of medical errors resulting in death. Anything that potentially risks negatively impacting such communication — even technology designed to help improve safety — should be closely evaluated to determine whether the technology is truly worthwhile and, if so, how to limit the undesirable effects.