Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them — which is more than the hours they spend with patients. Our investigation found that alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories.
Compounding the problem are entrenched secrecy policies that continue to keep software failures out of public view. Plaintiffs, moreover, say hospitals often fight to withhold records from injured patients or their families. Indeed, two doctors who spoke candidly about the problems they faced with EHRs later asked that their names not be used, adding that they were forbidden by their health care organizations to talk.
Says Assistant U. Though the software has reduced some types of clinical mistakes common in the era of handwritten notes, Raj Ratwani, a researcher at MedStar Health in Washington, D. I think few would argue they have. That was the real missing piece. As Biden would tell you, the original concept was a smart one. The wave of digitization had swept up virtually every industry, bringing both disruption and, in most cases, greater efficiency. Stowed in steel cabinets, the records were next to useless.
Nobody — particularly at the dawn of the age of the iPhone — thought it was a good idea to leave them that way. Bush and Barack Obama. KHN and Fortune examined more than two dozen medical negligence cases that have alleged that EHRs either contributed to injuries, had been improperly altered, or were withheld from patients to conceal substandard care.
For two days, the young lawyer had been suffering from severe headaches while a disorienting fever left him struggling to tell the operator his address. The multimillion-dollar system, manufactured by Epic Systems Corp. His results and diagnosis were delayed — by days, he claimed — during which time he suffered irreversible brain damage from herpes encephalitis.
The suit alleged the mishap delayed doctors from giving Ronisky a drug called acyclovir that might have minimized damage to his brain. Epic denied any liability or defects in its software; the company said the doctor failed to push the right button to send the order and that the hospital, not Epic, had configured the interface with the lab.
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Ronisky, 34, who is fighting to rebuild his life, declined to comment. Incidents like that which happened to Ronisky — or to Annette Monachelli, for that matter — are surprisingly common, data show. And the back-and-forth about where the fault lies in such cases is actually part of the problem: The systems are often so confusing and training on them seldom sufficient that errors frequently fall into a nether zone of responsibility. Critical or time-sensitive information routinely gets buried in an endless scroll of data, where in the rush of medical decision-making — and amid the maze of pulldown menus — it can be missed.
Thirteen-year-old Brooke Dilliplaine, who was severely allergic to dairy, was given a probiotic containing milk. The year-old man was sent home in from a Dallas hospital infected with Ebola virus. Though a nurse had entered in the EHR his recent travel to Liberia, where an Ebola epidemic was then in full swing, the doctor never saw it. Duncan died a week later. Bobby and Tara Dilliplaine hold a photo of daughter Brooke, who suffered complications when she was given medication she was allergic to.
She later died of causes unrelated to the EHR issue. Many such cases end up in court. Typically, doctors and nurses blame faulty technology in the medical-records systems. The EHR vendors blame human error. And meanwhile, the cases mount. In 13 percent of those cases, the mistake could have been fatal. The Pew Charitable Trusts has, for the past few years, run an EHR safety project, taking aim at issues like usability and patient matching — the process of linking the correct medical record to the correct patient — a seemingly basic task at which the systems, even when made by the same EHR vendor, often fail.
At some institutions, according to Pew, such matching was accurate only 50 percent of the time. Patients have discovered mistakes as well: A January survey by the Kaiser Family Foundation found that 1 in 5 patients spotted an error in their electronic medical records. Kaiser Health News is an editorially independent program of the foundation.
The Joint Commission, which certifies hospitals, has sounded alarms about a number of issues, including false alarms — which account for between 85 and 99 percent of EHR and medical device alerts. Such over-warning can be dangerous. From to , the commission tallied mostly voluntary reports of patient harm related to alarm management and alert fatigue — the phenomenon in which health workers, so overloaded with unnecessary warnings, ignore the occasional meaningful one.
Of those incidents, resulted in patient deaths. But what is perhaps telling is how many doctors today opt for manual workarounds to their EHRs. Further complicating the picture is that health providers nearly always tailor their one-size-fits-all EHR systems to their own specifications.
Such customization makes every one unique and often hard to compare with others — which, in turn, makes the source of mistakes difficult to determine. Martin Makary, a surgical oncologist at Johns Hopkins and the co-author of a much-cited study that identified medical errors as the third-leading cause of death in America, credits EHRs for some safety improvements — including recent changes that have helped put electronic brakes on the opioid epidemic. We used to struggle with handwriting and missing information. The EHR maker initially blamed the doctors, said Schneider.
A broad coalition of actors, from National Nurses United to the Texas Medical Association to leaders within the FDA, has long called for oversight on electronic-record safety issues. Ratwani spent his early career in the defense industry, studying things like the intuitiveness of information displays.
Zach Hettinger to see how doctors interact with EHRs. Kirkpatrick for Fortune. In a study published last year in the journal Health Affairs, Ratwani and colleagues studied medication errors at three pediatric hospitals from to When emergency room doctors went to order Tylenol, for example, they saw a drop-down menu listing 86 options, many of which were irrelevant for the specified patient.
Documenting Death -- The Certificate
Ratwani is pushing for a central database to track such errors and adverse events. Others have turned to social media to vent.
The good news, of course, is that the scope of the problem in Texas is probably much smaller than we thought. The original Texas numbers were calculated with the standard method a. The root of this data problem can actually be traced to , when the federal government added a pregnancy or postpartum checkbox to the U. The idea was that this would improve maternal mortality data collection, but as Texas shows, the opposite can happen. Meaning: A handful of accidentally checked boxes can completely throw off the scope of the problem on a state level.
The fact that we still figuring out the best way to measure the scope of the problem, and that the federal government has known about this confusion for a decade and has done nothing about it, suggests a galling cluelessness and lack of care for maternal health. It remains true, even when you account for the data collection problems, that the overall trend in maternal mortality in the United States is an upward one , making the U. We also know that maternal mortality disproportionately affects Black mothers, who are between three and four times more likely to die from pregnancy-related causes than white women, even when you control for socio-economic factors like income and education levels, according to a report from the Center for Reproductive Rights and the Black Mamas Matter Alliance.
Even in the revised Texas numbers this holds true: The maternal mortality rate for Black women was still double the overall rate, at Despite what we know about these general trends, having a detailed and accurate accounting of the problem is crucial for the health of all people who plan to have kids.
Are medical mistakes really the third leading cause of death in the U.S.?
The study, which relied on a national inpatient data sample from to , compared complication rates in July with August and June. The July effect may be difficult to capture because it may not permeate all specialties or types of hospitals, said Robert Huckman, PhD, associate professor of business administration at Harvard Business School.
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The studies to date provide enough suggestive evidence that it's worth continuing to research the July effect, said Don Goldmann, MD, senior vice president at the Institute for Healthcare Improvement. Such an effect is inherently logical, he added. To mitigate any potential impact, academic medical centers have invested increasing time and resources on lengthy orientations and closer monitoring of residents, Dr. Goldmann noted. Today's orientation for residents looks much different than when physicians like Dr.
Conroy launched their careers. First-year residents now arrive a week or two prior to July 1 for a barrage of training that encompasses not only hospital policies and procedures, but also the idiosyncrasies of that facility's computer systems, Dr. Conroy said. At the same time that the new residents are learning the ropes, the other residents are adjusting to increasing levels of responsibility all the way up to the attending level, she said.
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That hospital-wide shift, and resulting communication challenges, could play a significant role in the July effect, if it does exist, she noted. For first-year residents, incorporating simulated training sessions as part of orientation can help, she said. The simulations can also allow attending physicians to gain an early sense of which interns may have problems communicating with other clinicians and address those problems.
At Saint Vincent Hospital, part of the orientation includes the use of standardized patients in various clinical scenarios to teach skills like how to break bad news, Dr.