By Greg Freeman
EXECUTIVE SUMMARY
The Department of Veterans Affairs (VA) reported significant patient safety issues with its new electronic health record (EHR). Healthcare entities may need to check for similar problems in their own EHR.
- Thousands of clinical orders disappeared from the system, the VA said.
- Some patients were billed for imaging the system failed to order.
- Patients missed follow-up care because of the errors.
The Department of Veterans Affairs (VA) reported significant problems with its effort to implement a new electronic health record (EHR) that could affect patient safety. Hospitals and health systems using the same EHR may need to investigate whether they are experiencing the same issues.
In its recent EHR Modernization Sprint Report, the VA outlined four major patient safety issues it encountered when trying to implement the Oracle Cerner EHR. One of them is an “unknown queue” issue that had been flagged by the VA’s inspector general. This problem resulted in thousands of clinical orders disappearing to an unmonitored inbox. Some patients missed follow-up care because of that error.1
The EHR also failed to follow up and reschedule appointments for patients who canceled or missed appointments. It did not adequately handle referrals. Usability issues were reported, such as billing patients for medical imaging but not ordering the clinical imaging.
Patient safety issues are not unique to the product used by the VA, says Paul F. Schmeltzer, JD, senior attorney with Clark Hill in Los Angeles.
“I’ve never found an EHR product, off the shelf or otherwise customized, that was 100% perfect for our client in any given situation. There always are hiccups here and there,” Schmeltzer says. “But the real issue here is they are trying to improve outcomes and interoperability. They decided on this sort of product, but they identified these four key patient safety-related areas of focus. These are all related to various aspects of treatment of patients where there could be a poor patient outcome.”
The unknown queue and related issues are a big problem to address and pose significant risks to the patients, not to mention liability risks to the hospital, Schmeltzer says. For someone who needs critical medication, that oversight could be extremely dangerous. The failure to notify of no-shows or to reschedule appointments also could be serious.
“Again, this is not only isolated to this product because I’ve had many clients that have had similar scheduling issues where the EHR fails to reschedule or notify patients or the practice that a patient canceled or they were no-show and they need to reschedule,” Schmeltzer says. “The patient sort of falls through the cracks. There are some liabilities for that, particularly if they have a chronic health condition that needs routine management and oversight.”
Several of Schmeltzer’s clients experienced that issue with their EHR during the pandemic. One resulted in a complaint to the Office for Civil Rights (OCR) regarding the failure of the EHR to notify the practice of the no-show or canceled appointment, and the failure of the practice to reschedule that appointment. In another case, it was a failure from an automated system, directly connected but unrelated to the EHR, that failed to notify the patient of a change in an appointment status. That led to another complaint to OCR.
The lack of referrals created or sent to the proper entity predates the VA using the new product, so whether that problem is solely the fault of the EHR is unclear.
“The legal exposure here for the VA is that you may have patients who have critical needs that are not being treated in a timely manner, especially if the referrals are taking months to be processed, or just simply falling out of their full process, or not even been started in the worklist process,” Schmeltzer says. “You clearly have patient endangerment issues by that happening.”
Similarly, the usability issue that bills imaging not ordered for the patient can leave the patient without critically needed care.
Check for Similar Problems
The VA report is a good reason for other healthcare entities to check for similar problems in their own EHRs, no matter the vendor, particularly if they implemented it off the shelf with no modifications, Schmeltzer says. Clinicians should be encouraged to regularly document and report any such issues tied to the EHR.
“Medical staff need to report discrepancies or errors to upper management if they are aware of a bug in the EHR that doesn’t allow for a provider’s referral for a patient to go to physical therapy, for example, to go through the system and then be sent to insurance,” Schmeltzer says. “The practice or hospital is looking at a liability issue in regard to that patient. If they don’t do so, then the issue persists. It’s not fixed, and the patients continue to have poor care and poor outcomes.”
It also is important to report any EHR errors to the vendor, Schmeltzer says. The vendors are receptive to error reports because it is in their own best interest to correct them. The hospital or practice should not pay for a faulty EHR.
“Healthcare entities can spend tens of thousands of dollars a month on these EHR products,” Schmeltzer notes. “If you are having patient safety issues that result in missed prescriptions, missed referrals, [and] missed diagnostic imaging orders, you are putting yourself in danger of potential lawsuits down the road. You shouldn’t be paying tens of thousands of dollars a month for that sort of exposure.”
REFERENCE
- Department of Veterans Affairs. EHRM Sprint Report. March 2023.
SOURCE
- Paul F. Schmeltzer, JD, Clark Hill, Los Angeles. Phone: (213) 417-5163. Email: [email protected].
The Department of Veterans Affairs reported significant problems with its effort to implement a new EHR that could affect patient safety. Hospitals and health systems using the same EHR may need to investigate whether they are experiencing the same issues.
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