Every day, online retailers use computer-based transactions to guide us through stepwise sequences, such as shopping for a pair of jeans, applying for a MasterCard, or booking a flight. As we follow these electronic pathways, we cannot go wrong, but if we omit critical inputs or make a wrong choice, the program does not allow us to proceed until we get onto the good. within the language of systems engineering, the transaction is “mistake-proofed.” Moreover, within the rare circumstance of a novel or very complex transaction, we will obtain the phone to figure through the difficulty with a content expert. This same mistake-proofing process and technology embedded within the electronic medical history (EMR) can take us toward the safer distance, higher quality, and more cost-effective health care.
EMRs improve patient safety by implementing computer-based physician orders that eliminate illegible handwriting and misinterpreted verbal orders. Checkbox options that provide only correct doses of medication prevent overdoses. Nurses now compare a code on the patient’s wristband with the label affixed to medication to confirm that the correct patient receives the proper remedy; such safety features are delivered through the EMR in everyday practice. The EMR serves as a platform for innovation and creativity. Detailed prompts can standardize and improve care.
Our experience suggests three key factors. The first is establishing best-practice standards, cutting back unwarranted variation in medical conditions management. Groups implement such measures with an institutional alignment on quality, and medical science societies even have a task. They lack authority to enforce standards but can facilitate alignment on recommendations broadly adopted across US medical practices. The Choosing Wisely initiative, founded in 2012 by the American Board of Medicine in partnership with Consumer Reports, has engaged 70 professional societies to provide many recommendations geared toward engaging providers and patients in discussions to avoid unnecessary care.
Second, medical centers and vendors should work together to embed more protocols into EMRs to assist physicians in making the most straightforward decisions. A priority should be the event of “hard stop” tools that will block unsafe or inappropriate care (e.g., the ordering of an unnecessary imaging test). These applications of the EMR are in early development. One obstacle to progress is the cost of allocating clinical and technical personnel to put in and maintain these projects. With medical centers under increasing financial pressures, the price limits the custom development of those tools.
Providers that embrace the complete functionality of the EMR have a benefit in gaining market share and in lowering their costs. Most importantly, doctors use the EMR to feature the deep knowledge and protection of digital mistake-proofing to the art of medication they convey to their patients.
