Finding Fault with Electronic Health Record Defaults

Rachel Olszewski

In a push to become more efficient, many doctors and hospitals have instituted Electronic Health Records, or EHR, systems, many of which rely upon computerized provider order entry systems, or CPOE. Though these electronic systems are meant to increase patient safety and improve care, they, like all computerized systems, are only as good as the data that goes into them.A recent study by the Pennsylvania Patient Safety Authority highlighted one risk of medical errors when computerized order entry systems incorrectly used default settings, standardized values for orders such as medication dosage amounts and frequencies or times for blood draws or laboratory tests. These default values may not be appropriate for all individuals and are meant to be customized for patients. The authority, a state agency charged with improving patient safety by reducing or eliminating medical errors, examined 1,249 records of incidents from June 2004 to February 2013. They discovered 324 medical “events” related to these default settings. Most resulted in no harm to patients, but they highlight the possible dangers of relying on these systems.“Although the use of default values is intended to improve efficiency and standardization, reports submitted to the Pennsylvania Patient Safety Authority indicate that patient harm can occur when a default value is used inappropriately,” the report concluded. The most common errors were medication being given at the wrong time (200 instances) or at the wrong dose (71 instances) or being stopped inappropriately (28 instances). No harm to patients was reported in 314 of the instances, while six resulted in an “unsafe condition” but no harm. Two patients were harmed by overdoses of medication, one when the default dosage of a muscle relaxant was higher than it should have been and the other when the default administration timing resulted in an extra dose of morphine being given. A third patient’s temperature spiked after a default stop time automatically cancelled an antibiotic; a fourth patient’s sodium levels rose when a default note caused caregivers to incorrectly conclude that an anti-diuretic already had been administered. In the cases where a cause of the medical error could be identified, the top three were a failure to change a default value, user-entered values being overwritten by the system, and incomplete information being entered, causing the system to insert information into blank parameters. The results of this study demonstrate the importance of human employees in making sure patients are being medicated and treated safely and responsibly. More automation may make our healthcare system more efficient but it also could risk patient safety if it’s not done with sufficient oversight.