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Arguably the most fundamental use of medical technology for hospitals and clinics is that of electronic medical records. It’s an incredibly basic form of technological implementation serving a not just integral but requisite function without which healthcare institutions would experience a setback to the tune of about half a century. That being said, new research has been published saying that this fundamental use of technology in medicine actually incurs some legitimate drawbacks that disadvantage patients more than anyone.
“There’s no question that electronic health records have clear benefits for clinicians and patients, and can improve the care process,” according to Raj Ratwani, the senior author of a new study conducted by experts from MedStar Health National Center for Human Factors in Healthcare, which is based in Washington, DC. “However, nearly all healthcare systems have adopted an [electronic health record system] and this technology has introduced some new risks to patient safety, as our study has shown.” Ratwani made these remarks in an official MedStar press release about the study that his team published in the Journal of the American Medical Association.
MedStar is a nonprofit healthcare organization headquartered in Maryland. Ratwani’s team gathered almost 2 million safety hazard reports from Pennsylvania clinics as well as some throughout other parts of the mid-Atlantic region of the U.S. Some 557 of those reports directly referenced an issue in which a patient was actually endangered by electronic health records. To be clear, EHRs are technically defined as being inclusive of but not exclusive to digitized medical charts with data pertinent to a patient’s medications, allergies, medical history and past doctor visits. Collectively, the Centers for Medicare & Medicaid Services say all the information held in EHRs are supposed to paint a comprehensive, detailed picture of a patient’s long-term health as well as immediate health circumstances.
The research team analyzed over 1.7 million Pennsylvania Patient Safety Authority reports. “Our view is that even one patient harm event that stems from electronic health record usability issues is unacceptable,” Ratwani explains, and this is a sentiment obviously spurred by the common medical oaths that physicians take to protect the sanctity of life and the quality thereof to the best of their ability. In addition to that, though, there is also the inherent legal incentive in countries like the US and the UK wherein tort malfeasance can result in arguably the most outrageous consequences for physicians as well as institutions.
The system, as is, has already proven its worth several times over, greatly mitigating all manner of medication errors to a far greater degree than paper medical charts ever did, but clinicians also claim that it can be vexing to try to work the relatively complicated software. “It’s clear that the introduction of electronic health records is not making things worse over time,” David Blumenthal explained as president of the Commonwealth Fund philanthropy and formerly the Obama Administration’s national coordinator of health information technology. He wasn’t involved in the study but had plenty to say about it. “But I think better-designed records could make things better still.”
Ratwani’s team wanted to figure out how to improve EHRs so as to deal with these admittedly uncommon but legitimate threats that they posed to patients. They analyzed safety hazard reports that nurses and physicians have reported regarding all manner of errors, and they deem these errors worthy of a close watch for about 84 percent of patients. There were other reports that pertained to actual life-threatening circumstances, and those merited close watch for less than a percent of patients. The solutions they’re looking for are, of course, multifaceted, but one is already established; that’s having well-trained healthcare administrators specifically tasked with spotting these errors.
Despite that, there remains the margin of human error, and Ratwani suggests that that margin could be covered if patients could monitor and handle their own medical records more easily. As it so happens, that’s one of the primary appeals to the forthcoming fruits of Apple’s research, as evidenced by the iOS 11.3 beta update released in January in the form of the iPhone Health app, which gives people immediate access to EHRs from over a dozen medical institutions. “An engaged patient is a safe patient,” Ratwani mentions. That data covers medical conditions, allergies, vaccinations, medical procedures, lab tests and vitals, and Apple collaborated with Johns Hopkins and Stanford Medicine to make it available.
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The issue here isn’t just accessibility but, rather, the ease of accessibility. Kaiser Foundation and other healthcare groups already streamline all this information for patients in such a way that people can check their EHRs from a desktop computer, laptop or mobile device by normal Internet browsing means, but Apple is attempting to take this all one step further and make it possible to simply consolidate all EHRs for any individual within a singular app. This only improves things, though, if people genuinely start checking their medical information regularly via that app to cover any mistakes that clinicians might make when accessing hospital records.
[researchpaper 리서치페이퍼=Cedric Dent 기자]