How to Avoid the Unintended Consequences of EHRs

| January 23, 2012

est practices for anticipating, avoiding and addressing unintended consequences of electronic health record (EHR) implementation. 

Electronic health records (EHR) can bring many benefits to providers and the people they serve. But deploying a new EHR system can also result in unanticipated and undesirable consequences, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).

Guide to Reducing Unintended Consequences of Electronic Health Records describes those consequences and then offers tips on how to anticipate, avoid and address them. While the guide was developed based on the experience of hospitals and physician offices, it may offer some valuable lessons to long-term and post-acute care providers.  

Rocking the Organizational Boat 

The AHRQ report, which was prepared by the Rand Corporation, suggests that EHR implementation can often rock the boat at an organization by bringing about potentially disruptive changes in the way the organization does business on a daily basis. As a result, an organization can find itself dealing with unexpected fallout associated with:

  • Clinician and staff roles: EHRs can represent an unforeseen time drain because they create more work for clinicians who must input more, and more precise, patient information, says the report. In addition, EHR implementation can also upset the power structure of an organization if clinicians baulk at being told what to do by the organization’s information technology (IT) department.
  • Attitudes toward technology: Negative consequences can result when staff members either don’t like the technology or like it a little too much. For example, clinicians who resist giving up their paper-based systems may end up creating 2 dueling systems that don’t serve anyone well, explains EHR Outlook . On the other hand, clinicians who depend too much on clinical support technology may reduce their reliance on the personal instincts and knowledge base that served them well in the past.
  • Gains and losses: While EHRs can streamline some organizational processes, they may also disrupt valued workflows. For example, the benefits of sending prescriptions directly to the pharmacy might be offset by the loss of checks and balances that come with a paper-based system. This is particularly true if the EHR system does not have a Clinical Decision Support system for medication management, for example. In addition, the direct, verbal communication that is built into paper-based models may be lost if staff members simply check a patient’s EHR instead of talking to a colleague about the patient.
  • Technical issues: As EHRs evolve, it will become necessary for the organization to invest additional money in inevitable system upgrades. In addition, organizations may be unpleasantly surprised when they encounter errors they’ve never experienced before, including those resulting from data-entry mistakes.

Ways to Avoid Consequences  

Lest the unintended consequences of EHR implementation appear too daunting, the AHRQ report provides myriad strategies for anticipating, avoiding and addressing those consequences both during and after the implementation phase. Here is a sampling:

During Implementation: 

  1. Define the project scope and set reasonable and measurable goals.
  2. Make sure users are well informed and engaged in the process.
  3. Use multiple mechanisms for collecting, analyzing and acting on user feedback.
  4. Determine and periodically evaluate metrics for success.
  5. Establish maintenance routines and support quality improvement.

After Implementation: 

  1. Involve staff in reassessing and improving the technology.
  2. Use interdisciplinary brainstorming to improve system quality.
  3. Protect data entry staff from undue distractions.
  4. Use manual or automated surveillance to monitor and report errors.
  5. Use root cause analysis to find the real cause of system errors.

A few CAST sponsors and members discussed similar strategies in the collection of case studies that CAST published recently as part of its Preparing for the Future report.