Medical mishaps

Conventional wisdom holds that electronic medical records will reduce medical errors in the United States, but there’s surprisingly little evidence to back that up.

When doctors found a nodule on her thyroid gland in 2001, Massachusetts resident Jerilyn Heinold was relieved that the growth was noncancerous. About three years later, her primary care physician suggested a visit to a specialist to make sure the tumor was not growing.

The endocrinologist determined that the tumor had not grown but, as a precaution, referred Heinold for an ultrasound test. The ultrasound report came back with the disturbing finding that the tumor had grown. The endocrinologist then told Heinold she needed a biopsy.

Heinold knew better. She dug into her medical records, available to her online as a patient of one of the forward-looking hospitals in the Boston area, and looked up the size of the original tumor. In fact, the tumor had not grown. The radiologists somehow had received incorrect information about the growth’s size in 2001.

Such anecdotes often help make the case that widespread use of electronic medical records would reduce the incidence of medical errors. That assertion is made every day, appearing on the Web sites of the Office of the National Coordinator for Health Information Technology and many others.

However, scientific evidence about the efficacy of EMRs in preventing errors is rather slight. In a report published last year in the Annals of Internal Medicine, researchers affiliated with the Southern California Evidence-Based Practice Center said they found few rigorous and generalizable studies of the effects of health IT.

“Although we did a comprehensive search,” the research team that Dr. Basit Chaudhry led reported, “we identified only a limited set of articles with quantitative data. In many important domains, we found few studies.”

One of the most frequently cited studies of EMRs and medical errors took place in the late 1990s at Brigham and Women’s Hospital in Boston. Researchers found a 55 percent decrease in serious medication errors when it introduced an e-prescribing system, known in the health IT world as a computerized provider order entry system. When the hospital enhanced the CPOE system with better decision support features, the reduction in serious medication errors reached 86 percent.

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