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Errors in default settings of electronic medical record systems raise risks for patients

| Friday, Sept. 6, 2013, 12:01 a.m.

Computer systems intended to help hospitals improve patient care may have inadvertently put hundreds at risk.

A report released Thursday by a state agency that researches health care quality found more than 300 instances of medication errors at hospitals across Pennsylvania over the last 10 years because computers did not have the correct settings.

The errors caused patients to receive their medications at the wrong time, at an improper dose or no drug at all, the Pennsylvania Patient Safety Authority said. In all but four cases cited there was no harm to a patient.

“We're just trying to better understand what goes wrong,” said Erin Sparnon, the authority's senior patient safety analyst and author of the report. The study was “intended to help instruct the field.”

The issue involved electronic medical records systems, which hospitals have installed under a federal mandate to manage patient care more effectively. The systems can be programmed to manage medication — types, dosage and times — that are administered to patients for specific care.

But in some cases, default settings were not adjusted for specific patients, complete data were not entered, causing the system to fill in the blanks, or information entered by users was overwritten by the system, according to Sparnon.

Most of the errors, or 200 cases, were related to patients receiving their drugs at the wrong time. Seventy-one errors were an incorrect dose, and in 28 cases the patient's medicine was stopped prematurely.

Sparnon examined the authority's database of more than 2 million hospital error reports. Two reports involved temporary harm that required medical intervention. In one case, a patient was hurt when his or her electronic record ordered a higher than intended dose of a muscle relaxant, the authority said. In the other case, a patient was given an extra dose of morphine.

In two other cases, medication errors caused prolonged hospitalization. In the first report, a patient's temperature spiked after a default setting canceled an antibiotic. In the second report, a patient's sodium levels kept rising because an antidiuretic was stopped.

The authority is prohibited by law from disclosing error reports for specific hospitals, spokeswoman Laurene Baker said.

Sparnon said there are likely many more errors related to electronic health records included in the authority's database, but her search method targeted only errors involving default settings. Her study was not intended to quantify all those errors, but to call attention to this specific problem.

She recommended that hospitals use default settings with caution and frequently review them to ensure they line up with doctor orders.

Patient advocates said hospitals cannot simply install computer systems to manage medication schedules and then expect all errors to disappear.

“There's been many studies showing the benefits of technology” in medicine, said Tejal Gandhi, president of the National Patient Safety Foundation. “But anytime there is new technology, there are going to be new errors.”

The Hospital and Healthcare Association of Pennsylvania declined to comment on the report.

Allegheny Health Network, the seven-hospital system owned by health insurer Highmark Inc., has not had medication errors related to default settings in its electronic health record systems, spokesman Dan Laurent said.

UPMC, the largest hospital network in Western Pennsylvania, declined to comment.

The federal government has mandated that hospitals across the country install digital record systems in an effort to reduce medical errors. The Department of Health and Human Services has started an initiative to better understand and fix unintended problems with electronic health records.

The initiative “is based on the premise that we need to learn more about the safety and safe use of EHRs,” spokesman Peter Ashkenaz said.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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