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EMRs and Medication Errors

November 26, 2017

A study from the Pennsylvania Patient Safety Authority found that in half of the medication errors in healthcare facilities, the leading factor was the computerized physician order entry (CPOE) function of the EMR and how it interacted with the pharmacy system. A majority (69%) of the errors reached the patient, though few caused actual harm. The most common cause of the EMR errors was that the system did not work or was offline or otherwise unavailable. CPOE systems contributed to 59% of dose omissions, 56% of extra doses, and 53% of wrong dose/over dose events. Communication issues were also identified including “free-texting instructions in the order comments field … and the contradictory instructions were overlooked by the pharmacist or nurse.”  Remember, these CPOE systems were supposed to save patients from harm. It didn’t happen.

A recent commentary in JAMA  proposed that a measure of a successful EMR revolution will be how much they are deimplented. Bloated unreadable records, information that is next to impossible to find, the increasing drain on physicians’ time caused by klunky EMRs, all of this can go away if we could just chuck the wasteful EMRs into the scrapheap of federal programs that didn’t work. There is a middle ground between the old paper system and what we have now. My medical records of how I care for my patient should serve only as a reminder to me, not be a legal document for billing purposes. I would gladly go back to struggling to read a few hand-written notes over the mess we’ve been shackled with now. My patients want me to look them in the eye when I care for them. Throwing the computer out of the office window will go a long way towards restoring that relationship.

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3 Responses to EMRs and Medication Errors

  1. Tracie Updike MD on November 26, 2017 at 9:42 pm

    I disagree. I like my EMR and have used it since 2005. Medication errors occur because most of my patient have no clue as to why or how to take their medications. Specialist change medications all the time without really explaining to the patient or to me the dreaded PCP. Don’t expect the pharmacist to help any at all because they don’t. Recently I quizzed a pharmacist about the medication; my patient had two bottles of Norvasc one at 5 mgs and one at 10 mgs both picked up on the same day. The pharmacist told me that it was not his job to know what the doctors were doing. Needless to say I was shocked. I spend most of my time with each patient going over their medications. I am self employed and have the luxury to see 8-12 patients a day. My salary is adequate and I sleep well at night.

  2. R Watkins on November 27, 2017 at 7:53 am

    We’ve stayed with paper.

    We love it.

    Our patients love it.

    The AAFP, CMS, and Judy Faulkner hate it, and think we should be punished.

    Something is very wrong with this picture.

  3. Spring Texan on November 27, 2017 at 8:13 am

    As to what Tracie Updike said, the medication errors she sees are rather different from those seen in institutions where the patient is not self-administering.

    The story about the pharmacist and the Norvasc is SHOCKING. Really really bad. I’d complain to his employer though it probably would do no good.

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