Messageboard

Unhappy Camper (Vol 1., Issue 18)

PDR Secure has partnered with several other health organizations to set-up a unique and much-needed website called www.eHRevent.org . The purpose of this site is to accept reports of, and analyze medical errors created by the use of electronic health records. Fellow pilots will recognize the format of this as being similar to the NASA-sponsored Aviation Safety Reporting System. The general idea here is to collect information on safety issues affecting the use of electronic health records, from whatever cause.

And there are plenty of causes. One can report to the web site any sort of event where it is discovered that the use or misuse of EHR caused, or may cause, errors of documentation or adverse effect on patient care or the health care system. The website will collect basic information on your brand and version of EHR, your report in your own words, and what position you hold in handling the EHR. While you must give your name and contact information to the website, they also ask you whether you desire to share your name and contact information with others. If not, they promise not to divulge.

PDR Secure is a Patient Safety Organization set up under protective rules established by the Federal Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), and is overseen by an independent non-profit called iHealth Alliance to ensure security and privacy of data collected by eHRevent.org.

All sorts of problems with EHR use can be reported here, not just technical ones. Various training, security, network, and design issues are all open for gathering your complaints and comments. Unfortunately, the reporting website doesn’t seem to have a field for hardware problems, and different computer set-ups can actually make a big difference in how EHR errors are created. But you can type such information into one of the other product information fields, or address them in the free text reporting field.

Three of my problematic pet peeves (that I have mentioned here in previous columns) stood out as being worthy of submission to the site. First of all, I reported the particularly threatening pen-stylus picklist selection error (see http://www.docehrtalk.org/messageboard/2010/10/08/emr-data-entry-mistake... ). You might have picked the correct selection in a drug picklist, but what you picked may not be what’s entered into the medical records. No good fix that I know of for that one yet despite having downloaded updated drivers for the pen/stylus from WACOM. The second peeve was a problem inherent in touchpad – equipped tablets wherein the touchpad easily gets brushed while typing, allowing the text insertion point to move about, and resulting in gobbledygook text in the records. That bug, I can say, may have been fixed by downloading the new mouse driver, Synaptics TouchPad v6.2, onto my 4 Fujitsu machines. With that installed I could then disable Tapping, which may have created this problem. My third reported peeve was the annoying term “No Medical History Recorded” when there is no pertinent past history to record (as is frequently the case in pediatrics), but which implies that the physician didn’t bother to record anything — a bad semantics problem unique to my brand of EHR. (See: http://www.docehrtalk.org/messageboard/2010/09/08/emr-customization-not-... )

The American Medical Informatics Association recently released a position paper stating that "hold harmless" clauses in health IT contracts are unethical. Such clauses free health IT vendors from responsibility for errors or malfunctions of their technology. (See: http://www.ihealthbeat.org/articles/2010/11/11/amia-calls-for-accountabi... ). Reporting bad EHR design features to eHRevent.org will provide for increased pressure on vendors to play by the rules, and perhaps decrease our own liability for their mistakes.

As we encounter very disturbing disorientation aspects of not only our in-office EHRs but also all the totally different EHR systems in use at our hospitals, it will quickly become apparent that there is much room for error and adverse patient outcomes still to be had. We need to report these errors not only to our own IT people, but to this clearinghouse of horrors as well.