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The Electronic Medical Record / Computerized Patient Record Errors in medicine are frequent, just as errors are in all other aspects of life. The landmark 1999 Institute of Medicine report To Err is Human: Building a Safer Health System made four points1,2:
- the extent of harm from medical errors is great - errors are most often the result of process / system failures (rather than people failures) - achievement of acceptable levels of patient safety requires major process / system changes - a concerted national effort is needed to improve patient safety
1. Kohn LT et al. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999. 2. Bates DW et al. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc. 2001;8:299-308.
Individual care providers cannot possibly remember all of the best practice guidelines, different drug indications and combinations, drug-drug interactions, and the other facts and caveats required to deliver the highest quality care. Central to optimizing the delivery of care by individual providers is improving the processes and systems of care. In turn, this requires the judicious adaptation of information technology to facilitate the acquisition, confirmation, and delivery of care. The EMR initiative seeks to create an integrated approach to several aspects of care of Heart Center patients. This will then permit the implementation of clinical decision support, reduce both errors of omission and commission, and improve the quality of care.
Guiding principles. It is clear that a paradigm shift is ongoing in the Health Care industry. A recent talk by Donald Berwick encapsulates the change from the "old" to the "new" rules that need to be adopted to "cross the quality chasm".
Two particular focuses are computerized order entry and solutions for practice management.
Computerized Provider Order Entry. Specific to the inpatient environment, computerized order entry reduces opportunities for clerical errors, has the potential to incorporate clinical decision support, and improve the quality and efficiency of medication use. Systems can be embedded with knowledge content, patient safety alerts, and other technology solutions to reduce both medical errors and variance.
Key personnel: Gary Stiles, Mike Russell, Berit Jaison, Jimmy Tcheng
The Electronic Health Record. A number of vendors have created electronic medical record systems that manage inpatient, outpatient, telephone, consultative, prescription authoring, and other types of patient encounters. The key advantage of these systems is the essence of the electronic medical record / electronic health record (EMR or EHR), i.e., the electronic capture, in a codified format, of information that can be analyzed and propagated from one encounter to the next. This reduces repetitive tasks, creates the data input for decision support and analysis, reduces transcription errors, improves documentation and compliance, and facilitates communication among all care providers.
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in this web are proprietary to Duke University Health System. Questions,
comments, suggestions, or problems regarding this web site should be directed to
James E. Tcheng, MD. |
