While technology can help improve patient safety, it is not foolproof.
Electronic medical records (EMR) are a classic example, with studies confirming
that they can sometimes do more harm than good.
In a recent
Wall Street Journal article, Dr. John Sotos, M.D., a cardiologist, flight surgeon, and former medical
technical adviser on the TV series "House," detailed how the
distractions that result from EMRs can lead to potentially deadly mistakes.
“Without doubt, electronic medical records are killing and injuring
people, for some of the same reasons that airplanes crash,” he writes.
To demonstrate his point, Dr. Sotos describes how hospital staff treating
a patient he calls “Alex” botched orders for intravenous (IV)
fluids three times in three days. Upon admission to the hospital, Alex
was not allowed to eat or drink, but the staff failed to order fluids
for her. On Day 2, they gave her 3 times the IV fluid she needed (resulting
in excessive urination and "brisk bleeding around the catheter sites").
On Day 3, when she again couldn't drink, the medical team again failed
to order IV fluids.
According to Dr. Sotos, the fluid mismanagement errors are linked to the
use of EMRs. Alex’s nurses devoted less attention to the fluid status
of the patient because their attention was channelized to the EMR system,
something he argues didn’t happen 20 years ago when nurses simply
entered the information in a clipboard attached the hospital bed. He writes:
Today, nurses at Alex’s hospital are, almost literally, chained to
a computer station with wheels that runs the EMR and goes with them from
patient-room to patient-room. A basic nursing task, such as documenting
a patient’s urination, requires the nurse to walk to the computer,
sign on to the EMR (itself a chore), grasp the mouse, select the patient,
click a “urination” tab (eventually), move hands to keyboard,
type the volume of urine, then click “save.” Any new data,
alerts or orders on the screen will distract the nurse from thinking about
the significance of the urine volume just produced.
To address the distractions caused by EMRs, Dr. Soto recommends that EMR
vendors design computer interfaces to be “undemanding of attention
and cognition.” Comparing a distracted nurse to an airline pilot
who spends more time fiddling with a broken intercom than flying a plane,
he concludes: “Like cockpit controls, a critical component in a
critical system that must be designed to be undemanding of attention and
cognition. Anything less will create new cemetery plots, as surely as
poor cockpit controls create smoking holes.”
If you or someone you love has suffered from medical error linked to electronic
medical records, don’t hesitate to contact
a San Diego medical malpractice attorney at the Law Offices of Robert Vaage
for a free consultation.