Discussed in this post: “How Often Do EHRs Result in Patient Harm?(AJN, News, March).

When we first had computers in the hospital—that is, while we still charted on paper but had quick online access to lab, radiology, and pathology results and could easily look up a patient’s prior admission history—it was wonderful. No more little lab slips floating all over the nurses’ station. No more unit-to-unit searches trying to figure out who last had custody of the patient’s X-ray films. (How could objects so large be so easily lost?)

A rocky transition to EHRs.

electronic health recordsThe transition to almost fully digital charting, on the other hand, has been pretty much a nightmare from the beginning. Nursing was rarely included in initial needs assessments. Many rollouts were chaotic, without additional staffing for the inevitable glitches that are bound to occur. Training of frontline clinical staff has been routinely minimal; we seem to be expected to pick up the many fine points of new software by some kind of digital osmosis.

That elusive clinician friendly EHR.

It’s very clear at this point that electronic health records (EHRs) were designed primarily for data collection and billing purposes. I have yet to see a system that could in any way be called clinician friendly. We are not communicating as clearly as we used to, and it’s a little tiring to keep hearing “But isn’t it great that we don’t have to decipher handwriting anymore!?” One advantage does not transform a labyrinth into a model.

Read more about this serious but still unacknowledged issue in “How Often Do EHRs Result in Patient Harm?” in this month’s AJN, which notes findings of a 2019 joint investigation by Kaiser Health News and Fortune magazine that found serious documented and potential patient safety issues traced to computer system errors:

“The authors describe systemic [computer] failures in transmission of physician orders, mix-ups in patient profiles that could lead to potentially catastrophic medication errors, and issues with ‘interface,’ where online systems used by pharmacies and laboratories for example, might fail to communicate with each other.”

Incredibly, there are no reporting requirements for near-misses or actual patient harm that has resulted from these computer issues.