A new online guide is available from the U.S. Agency for Healthcare Research and Quality (AHRQ) to help hospitals and other health care organizations anticipate, avoid and address problems that can occur when adopting and using electronic health records.
The free tool, called the “Unintended Consequences Guide,” was created to provide practical troubleshooting knowledge and resources. Experts from the RAND Corporation, the University of Pennsylvania School of Medicine, Kaiser Permanente-Colorado and the American Health Information Management Association Foundation created the guide. The work was supported by a contract from the Agency for Healthcare Research and Quality.
The “Unintended Consequences Guide” is designed to give providers practical advice and tips for dealing with the unanticipated problems sometimes associated with EHR systems, noting that “unintended consequences can undermine provider acceptance, increase costs, sometimes lead to failed implementation, and even result in harm to patients.” Examples of unintended consequences noted in the guide include:
- Increased work for clinicians, such as more documentation;
- Unfavorable workflow changes;
- The need for more resources to implement and maintain an EHR system;
- Conflicts between electronic and paper medical records;
- Changes in communication practices;
- User frustration;
- New errors, such as inputting into the wrong field;
- Unexpected changes in the institution’s power structure;
- Overdependence on technology.
The tool provides step-by-step guidance to help future and current users avoid these unintended consequences, to understand and identify them, and to remediate as needed. It also provides an appendix of helpful case examples, such as how to reduce medication errors and responding to alert fatigue.
“The goal is to provide administrators, technology officers and health care providers with information that will help them successfully adopt and use electronic health records,” said Spencer Jones, an information scientist at RAND and a co-author of the guide.
“Moving from paper records to electronic records is a major undertaking and the ‘Unintended Consequences Guide’ is an essential tool to help that migration.”
“One of the purposes in funding this effort was to help health IT implementers understand the interactions between humans and technology that are often the source of unintended consequences,” said Michael Harrison, a senior social scientist with the AHRQ and a collaborator on the guide.
“Having recently completed the largest civilian roll out of a national electronic health record system in the United States, we want to share our knowledge about implementation and how electronic records can transform health care delivery,” said Dr. Ted Palen of the Kaiser Permanente-Colorado Institute for Health Research.
Use of electronic health records is growing rapidly among hospitals and other health care providers in the United States, spurred in part by major federal investments in the technology. Legislation approved in 2009 eventually may provide as much as $30 billion in federal aid to hospitals and physicians that invest in electronic health records. The guide was developed for use by all types of health care organizations – from large hospital systems to solo physician practices.
The creators anticipate that the primary users will be those responsible for adopting electronic health records, including federally designated Regional Extension Centers, chief information officers, directors of clinical informatics, electronic health records “champions” or “super users,” administrators, information technology specialists and clinicians involved in adoption of the technology. Frontline users of electronic health records such as physicians and nurses also may also find the guide useful.
The online resource is based on the research literature, other practice-oriented guides for electronic health record adoption, research by its authors and interviews with leaders of organizations that have recently switched to electronic health records.
The guide represents a compilation of the known-best practices for anticipating, avoiding and addressing unintended consequences of adopting electronic health records. However, researchers say, this area of research is still in its infancy