On September 25th, 2014, a 42 year old Liberian man in the U.S. visiting family fell ill and went to a Dallas, Texas hospital for treatment. He told the nurse that he had fever and abdominal pain and was from a West African country that was in the midst of an Ebola outbreak. The nurse duly noted this in their state of the art electronic health record (EHR) system and passed him along to the ER physician. He was sent home with antibiotics. Eleven days later he became the first person in the U.S. to die of the Ebola virus and set up an epidemiological nightmare.
An Expert Panel Report convened by the hospital discovered that the travel documentation entered by the nurse was in the system, but required the physician to navigate to another part of the system to find it.
EHR’s have been around in one form or another since the 1970’s, but really took off in the 21st century. In 2001, 18% of physicians were using EHR’S while that figure rose to 57% in 2011. In January of 2009, the Health Information for Economic and Clinical Health Act (HITECH) was signed into law which provided incentives for adoption that will be phased out in 2016 and replaced with penalties for not using them.
The benefits touted from the use of EHR’s are many: Improved care coordination, increased efficiencies and cost savings, improved diagnostics and patient outcomes, etc. In the real world, the results have been mixed at best. CRICO, a malpractice insurance provider, studied medical errors in 2013 and found that 20% could be directly related to EHR’s.
Other case studies show errors made when database fields are inexplicably dropped, say a penicillin allergy or blood thinner therapy just disappears, leading to a potentially life threatening situation. Interoperability is an ongoing problem. There are no set standards and when EHR’s are transferred offsite, incomplete and mangled data has occurred.
Malware is a growing concern and medical information is arguably one of the most popular targets. Healthcare IT is way behind and no one really knows how many thefts of medical information have occurred. One study found 1.7 million EHR’s exposed in the first four months of 2015 alone. To illustrate what can happen when a medical identity is stolen, consider the Salt Lake City mother of four, who was threatened with losing custody of her children when a woman using her medical insurance delivered a baby who tested positive for meth and then left the hospital without the newborn and $10,000 of unpaid bills. Additionally, the woman who used her identity had a different blood type and the victim is still not sure if the record is corrected because of a Gordian Knot of HIPPA regulations that prevent her from looking at her records because they were used by someone else!
Two things are clear regarding EHR’s. They are fundamentally flawed, and they are here to stay. It is now past time for leaders to speak up and correct these issues that lie at the heart of our health care industry. Failure to do so will only lead to more catastrophic results.
Jeff Harris is a Pharmacist with over 25 years of leadership experience in hospital, retail, and home health environments. Due to a spinal cord injury, he is currently on long term disability. Jeff is passionate about patient safety, risk management and cybersecurity issues in healthcare. He continues to research and write about improving healthcare on a pro-bono basis.