August 2, 2016

What about EPR, and the patient safety?

“All men make mistakes, but a good man yields when he knows his course is wrong, and repairs the evil. The only crime is pride.”— Sophocles, Antigone. Avoiding patient harm is the next challenge for the healthcare industry. Everywhere. When we stop and think about it, the words which spring to mind include “surgical checklists”, “safety procedures”, “hand washing” and so on.

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But what about EPR? What could we do about patient safety from an EPR / EHR / EMR point of view?

The Problem

Let me consider the following scenario: patient harm due to medical errors.

Most of these errors are avoidable. In 2013, the “Journal of Patient Safety”  said that there are from 210.000 to more than 400.000 premature deaths per year in the U.S. which are associated to preventable harm to patients.

In Spain we’ve got statistics from “Asociación de Defensa del Paciente”, measuring the number of sues due to medical errors. In 2015, there were 14.430 medical errors sued (with a majority of them due to waiting list issues), with 806 deaths related to them.

It’s a shame

These statistics come to no surprise when we realise the amount of lawyers who are encouraging patients to sue when they detect any kind of complaint about their care. That means increasing costs of medical practice due to the growing costs of civil responsibility insurances that every healthcare professional has to have. That is in US, but we can see it in Spain, too.

A way to fix it

Again, what could we do? We could do a lot of things, sure. We would improve the decision-making processes. In particular, we could examine how a doctor evaluates signs, symptoms and results of laboratory and image tests to determine a given diagnostic.

These kinds of processes are supported by clinical guidelines, approved by the CMO, or given by healthcare regional and national administrations. These guidelines have a decision-driven flowchart (or something similar) which specify each step doctor has had to do. It’s the safest way to conduct diagnostic treatment processes, because they are evidence based, peer-reviewed procedures. Following a clinical guideline is safe for the patient, but also for the healthcare professional. And it’s cheaper for all the stakeholders, too.

And what about EPR? Well, the implementation of clinical guidelines in a commercial EPR tends to be a limited document attachment with no business rules embedded, out of the possibility to present it when a given condition has been reached (for example, by a symptom with a threshold value or by a specific diagnostic).

The proposed solution

And what’s the challenge? It would be embedding the decision flowchart as a set of business rules into the EPR. That is, the EPR would follow the diagnostic decision-making driven by the clinical guideline, assessing the healthcare professional in each step, showing the right diagnostic and treatment options at every moment, avoiding mistakes and protecting patients with the safest, convenient procedures.

That means EPR would be transformed from an input tool with limited intelligence to a veritable medical record and assessment tool. A system designed to improve patient safety. The proposed EPR is a system that is preventing harm. It’s our goal.

Consider, for example, a female patient, with a suspect of breast cancer. All the symptoms and tests reveal that it’s breast cancer. But the healthcare professional didn’t have the biopsy results. And without them, they can’t make a final diagnose of breast cancer. In a commercial EPR, the system would allow to record a final diagnose of breast cancer.

In our proposed smart system, EPR warns us about the lack of biopsy results, and offer the option to order them if we didn’t ordered, showing a CPOE window with the right options pre-selected.

This is only one example of how we can improve patient safety linked by an EPR.


There is a lot of work to do.
One of the most famous quotes of Star Trek was: "To boldly go where no man has gone before…"It’s time to come together, explore the EPR technology boundaries, to ultimately improve patient safety.

This is one of topics to be discussed at the new HIMSS Europe World of Health IT (WoHIT) Conference & Exhibition which will be taking place on 21–22 November 2016 in Barcelona, Spain.

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