Practice Management Alert

Question: What should our practice do to prevent unintended consequences from electronic health record (EHR) use? We are especially interested in the steps we can take to monitor EHR usage and avoid problems due to system updates.

Oklahoma Subscriber

Answer: The most important thing you can do to prevent unintended and adverse consequences of EHR use is to continuously monitor its functionality and use, according to the Office of the National Coordinator for Health Information Technology (ONC). Keep in mind that unintended consequences don’t happen only during the initial EHR implementation phase, but instead they can occur at any time before, during, and even long after implementation.

The ONC provides the following recommendations for improving EHR safety and helping to avoid unintended consequences during day-to-day use:

• Actively involve clinicians and staff in technology reassessment and ongoing quality improvement.
• Continuously monitor for problems and address any issues as quickly as possible.
• Employ interdisciplinary brainstorming methods to improve system quality and provide feedback to vendors.
• Carefully review skipped or rejected alerts from the EHR system.
• Require departmental or pharmacy review and sign off on orders created outside the normal parameters.
• Create an environment that protects staff involved in data entry from undue distractions when using the EHR system.
• Continually reassess and enhance safety effectiveness and error-detection capabilities, including the use of error tracking tools and evaluation of near-miss events.
• Use manual or automated surveillance techniques to continually monitor and report technology-caused errors and near misses or close calls.
• Pursue system errors and multiple causations using root cause analysis or other forms of failure-mode analyses.