While experts generally agree that the move from paper-based medical records to electronic medical records was...
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a good move, studies show that EHR errors are common and that the information in patients' medical records is often inaccurate.
Dhruv Khullar, a resident physician at Massachusetts General Hospital in Boston, talked about this problem during a panel discussion at the Health Datapalooza conference in Washington, D.C., citing his own experience as a doctor as well as the findings of several studies.
One study found that only 5% of cases accurately list a patient's medication in his or her EHR while another study found that 50% of medications listed are inaccurate, Khullar said. Furthermore, another study found that 60% of doctor's daily notes have at least one error.
How EHRs make it easier for mistakes to happen
Khullar explained that these EHR errors are happening because of the way EHRs are set up and how they allow physicians to enter patient information.
Dhruv Khullarresident physician at Massachusetts General Hospital in Boston
For example, EHRs allow physicians to copy and paste information, which can propagate errors and lead to something Khullar calls "note bloat," or "notes that are so bloated with excess information that you have to scroll through pages and pages of nonsense to find anything that's useful."
Another issue is that many doctors' notes are auto-populated, where large amounts of patient information are automatically imported into patient notes. Not only does this add to the problem of "note bloat," but it also creates a different experience for physicians. "Cognitively it's a very different experience to ask about, confirm and then personally record something into the medical record than simply review what's already written there," Khullar said.
"Right now, we document because we can," he added. "What gets lost in the excess, I think, is the patient's story."
What can be done to decrease EHR errors
Khullar said that "it's no surprise that both doctors and patients are struggling with all this paperwork." He added that a study found that some practices spend two hours every day just documenting quality metrics.
Khullar suggested ways to improve EHRs and begin to decrease the number of errors:
1. Only capture what is most important. "I think we need to be more high-yield in how we go about this," he said. "To me, that's number one." The patient data Khullar considers most important is information that gives him a sense of who his patient is, what the patients' goals are surrounding their health and what type of medical work up the patient has received that will inform the way a physician is going to care for that patient. "Everything else is just excess."
2. Make the art of story gathering and storytelling mandatory. "Distilling and communicating what has happened in someone's life, it really is the heart of medicine and we spend so much time documenting things, but what needs to be mandatory in the digital age is the art of story gathering and storytelling," Khullar said.
3. Encourage more patients to read their medical records. "Doctors may be more likely to write thoughtful and accurate notes if they know their patients are going to be reading them, and patients have the opportunity to correct inaccuracies, but also to engage in their medical records to learn more about their conditions and to learn more about their treatments," Khullar said. However, only 40% of patients are offered access to their medical records, he added.
"Only half of those patients actually choose to view them. But also, all patients who do [view their medical records] find it to be a useful exercise," Khullar said. "The patients that take the time to view their medical records may be more motivated to take control of their health; they may be in a better position to correct any inaccuracies that are in the record."
4. EHRs should be like scrolling through an iPhone. "Make medical records generally something that people want to engage with," Khullar said, "something that both doctors and patients both really want to use."
Khullar imagines this to be like scrolling through an iPhone or reviews on Yelp or photos on Instagram.
"I want it to be that easy to use, and I think because [right now] they're so bloated and clunky it's easier for mistakes to slip in," he said.
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