Electronic Health Records No Guarantee of Quality Health Care

As a reminder that electronic health records (EHR) are not a quality health care panacea, consider the two following healthcare stories involving the US Department of Veterans Affairs.

First, in yesterday's New York Times, there was a disturbing story of what the Times calls a "rogue cancer unit" operating out of VA Medical Center in Philadelphia, Pennsylvania, "one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six year - and then kept quiet about it."

The Times story indicates that, "The 92 implant errors resulted from a systemwide failure in which none of the safeguards that were supposed to protect veterans from poor medical care worked... Peer review, a staple of every good hospital, in which colleagues examine one another’s work, did not exist in the unit."

As part of the story, the Times also published the medical records of one patient, all duly written up in the VA's VistA highly lauded (and deservedly so) electronic health record system. VistA is being touted by some as an inexpensive way for hospitals to implement an EHR system. However, as the Times story graphically indicates, an EHR system by itself doesn't guarantee quality health care.

Furthermore,  the Times story points out another issue that needs to be considered by the folks who are defining what "meaningful use" of EHRs means in order that doctors and hospitals can qualify to receive stimulus money for their EHR system purchases. As noted above, even though critical patient medical information indicating systemic quality problems was being captured in VistA, no one bothered to independently examine the information for those potential problems.

To me, this means that the definition of "meaningful use" needs to go beyond just the technical capabilities of an EHR system to how it is supposed to be used in practice.

In yet another on-going and disturbing story involving the VA that hammers home that EHRs do not guarantee that health quality issues will magically go away, the VA's inspector general reported last week that fewer than half the VA medical facilities selected for random inspections had properly sterilized medical equipment used for colonoscopies. The reason for the IG's audit were reports that 10,320 veterans had been potential exposed to hepatitis B, hepatitis C or HIV at VA medical facilities in Miami, Florida, Murfreesboro, Tennessee, and Augusta, Georgia, by the use of improperly sterilized equipment going as far back as 2003.

Again, just because a hospital or doctor's office has electronic health records, don't expect the quality of health care to improve signifcantly improve without other medical safety process improvement actions being taken as well.

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Willie D. Jones
 
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