Increased EHR use offers advantages, despite patient safety barriers

ASHP survey released; AHRQ, in response to data from last decade, has proposed recommendations to improve EHR-related safety

Responders to the American Society of Health-System Pharmacists (ASHP) National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing—2016 conveyed that health care institutions across the country are increasing their use of information technology (IT). This development has contributed to the expansion of pharmacy services and has offered several clinical advantages in both inpatient and outpatient settings. However, with 99% of hospitals now virtually paperless and operating on electronic health records (EHRs), some unexpected challenges in patient safety have emerged.

Survey authors underscored the potential for EHRs to improve access to medical information and expedite services with integrated features such as clinical decision support (CDS) and real-time safety alerts. Nonetheless, flaws concerning safety in project planning, implementation, and management have historically produced unintended consequences in a support area that may be expected to continue advancing and expanding in use. To enhance EHR system-level practices affecting patient safety, clinicians should review system trends and identify opportunities for improvement. 

In response to EHR implementation and safety data measured over the last decade by the Agency for Healthcare Research and Quality (AHRQ), its own Patient Safety Network has proposed several recommendations to help clinicians and health care organizations identify, promote, and manage methods to improve EHR-related safety. During project planning phases, it is important to anticipate implementation and management issues. By doing so, proper investment can be made to protect patient safety in light of foreseeable barriers such as routine EHR upgrades, system-to-system interface changes, organizational leadership changes, CDS failures, or hardware failures.

For issues that slip through the cracks, recommendations stress the importance of proactive monitoring of system performance that involves more than a simple voluntary user reporting approach. A successful quality improvement plan will test individual EHR components; monitor user activity logs, system error logs, and system performance; and use computer-based indications for potential errors.

Other guidance provided by AHRQ describes administrative best practices. Leadership must provide the appropriate personnel. Clinicians all too often lack the time and expertise needed to design, build, implement, and test fail-safe large-scale EHRs. Management should also recognize that many safety-focused solutions can reduce clinician efficiency and cost time in the short term. Even still, other fixes will require purchasing and maintaining high-quality equipment. To maintain an environment conducive to continuous process improvement, administrators should share responsibility for EHR safety with vendors, government regulators, health care organizations, and users.

For the full article, please visit for the upcoming December 2017 issue of Pharmacy Today.