We're all looking at the same patient safety elephant

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There's been little fanfare about this week's survey results from global physician social network SERMO regarding the apparently different views American and European doctors have about electronic health records and patient safety. More than half of the European doctors polled viewed EHRs as improving patient safety; just 11 percent thought that EHRs negatively impacted patient safety.

American doctors were much more doom and gloom, with only 27 percent believing that EHRs improved patient safety, and 39 percent saying that they worsened it.

This dichotomy of opinion is reflected in the studies about EHRs and patient safety, which according to SERMO is the reason why it ran this survey in the first place.  For example, SERMO pointed to a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ) which found that hospitals using EHRs had fewer adverse events, such as hospital acquired infections. SERMO contrasted that finding with an analysis of malpractice claims and lawsuits maintained by CRICO, owned by the Harvard medical community, which found 248 malpractice cases showing serious unintended consequences from use of EHRs that caused patient harm.    

This lack of consensus is not new. We've even seen it within the same report. The Institute of Medicine's most recent report on patient safety, which reviewed diagnostic errors, found that EHRs both help and hurt patient safety. According to the report, EHRs are great tools that support diagnoses, can scan for problems, mitigate human limitations and provide clinical decision support. But at the same time, they contribute to and can cause diagnosis errors with poor design, poor integration into workflows, user error and poor usability.

The truth is that the lack of consensus on EHRs and patient safety doesn't mean that the studies--or the physicians' divergent viewpoints--conflict. 

Here, we know that EHRs both positively and negatively impact patient safety. They can and do improve individual and population health. But their design and the clinicians who use them aren't perfect, and they can contribute to adverse patient safety events, such as medication dosage mishaps, system related problems, loss of data needed to make treatment decisions, and the like.

It's like the old folk tale about the blind men and the elephant. They're asked to touch an elephant and describe what it's like. They each touch different parts of the elephant and form different views about what the animal is. The one who touches the leg believes the elephant is a pillar; the one who touches the tail thinks the elephant is a rope; and so on.

It turns out that they're all right; when all those views are put together, a more complete, accurate picture comes into focus. 

It's the same with EHRs and patient safety.

It would have been helpful for SERMO to ask in its poll why European doctors were more bullish on EHRs and patient safety than Americans. Are more Europeans using the same systems, so that interoperability and care coordination is better in Europe? Are their single payer healthcare business models creating more standardization? Do their laws discourage malpractice litigation? That would have provided an even more complete picture.   

The real key is what to do with the knowledge that EHRs have both effects on patient safety, and work to reduce their two-sided nature. Let's make sure that EHRs have more of a positive impact than a negative one. - Marla (@MarlaHirsch and @FierceHealthIT)

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