The electronic medical records market in the United States generates over $25 billion in revenue a year. However, many voices are now being raised, given the number of repeat errors which are endangering not only the overall standard of care given to patients but also their lives.
Driven by the Obama administration’s initiative to encourage nationwide use of Electronic Medical Record (EMR) systems by 2014, a growing number of US healthcare professionals are speeding up the digitization of their data processing services. According to a recent report by global management consulting firm Accenture, over 93% of the US doctors surveyed are already using EMR systems and half said they regularly access clinical data from outside their own organization, using Health Information Exchange (HIE) tools. However, at a time when the US Federal Drug Administration (FDA) has already warned electronic medical device manufacturers about the need to design more security into their products so as to counter the risk of cyber-attacks, a number of recent reports have been highlighting a variety of problems encountered during the transition to open digital processing of medical data. In many cases, these imperfections constitute a threat either to patients’ data privacy or to their actual health.
Repeated anomalies, communication failures
Taking medical records into the digital era in the United States has resulted in a large number of reported incidents, as recognized by the American College of Emergency Physicians. Inadequate software programs have for instance led to “wrong order-wrong patient” type errors and “poor data display” among other shortcomings. In Pennsylvania, the authorities noted that the number of errors linked to the use of EMRs is on the increase, rising to 1,142 in 2011, i.e. double those reported in 2010. In the latest example, the UnitedHealth Group recalled all its digital health record software – Picis ED PulseCheck – which is used in over 20 US states, because of an error that caused doctor’s notes on patient prescriptions to drop out of their files. The main reason for the errors observed appears to be the learning curve of healthcare staff, who were not entirely comfortable with the digital tools they needed to use for EMR processing. A report published recently by Bloomberg News indicates that the most dangerous time when patients are exposed to potential failures in the system appears to be immediately after a facility installs the new technology; after the initial adaptation phase, the number of systems irregularities drops significantly. Nevertheless, it is often difficult to trace a failure back to its source, i.e. basically to distinguish between human error and a fault in the system. Moreover, there is a shortage of feedback. First of all, the FDA does not impose any transparency rules on EHR users; and secondly many doctors complain that it can even be impossible to raise alerts on problems detected because of the ‘gag clauses’ in some software providers’ contracts that prevent medical practitioners from giving honest feedback on areas in need of improvement.
Results still impressive
However, it seems that the technological transition and the time necessary to train healthcare professionals are the main causes of error, and that mistakes are rarely due to inherent software problems. Meanwhile the new EMR approach to medical data processing is bearing real fruit. Two studies published this week in the Journal of the American Medical Association highlight the improvements brought about by this new data processing technology. The first study, carried out by California-based Kaiser Permanente, analyses the impact of EMRs on the health status of diabetics and reports that, post the transition to electronic processing, the number of A&E admissions and overall hospitalization fell by over 5%. Along the same lines, another study carried out in Finland underlined how effective EMRs were in helping to detect malformations in young children.