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Should US doctors embrace electronic health records?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j242 (Published 24 January 2017) Cite this as: BMJ 2017;356:j242
  1. George A Gellert, associate system chief medical information officer1,
  2. S Luke Webster, vice president1,
  3. John A Gillean, executive vice president1,
  4. Edward R Melnick, assistant professor2,
  5. Hemal K Kanzaria, assistant professor3
  1. 1CHRISTUS Health, San Antonio, TX, USA
  2. 2Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
  3. 3Department of Emergency Medicine, University of California, San Francisco, CA, USA
  1. Correspondence to: G A Gellert ggellert33{at}gmail.com, E Melnick edward.melnick{at}yale.edu

Moving to electronic healthcare infrastructure could help reduce an epidemic of iatrogenic harm, write George A Gellert, S Luke Webster, and John A Gillean. But hasty implementation has led to suboptimal systems that may jeopardize the clinician-patient relationship, say Edward R Melnick and Hemal K Kanzaria

Yes—George A Gellert, S Luke Webster, John A Gillean

Preventable healthcare related errors are responsible for 210 000-400 000 deaths a year in the US, making them a leading cause of death.12 Substantial evidence shows that electronic health records improve patient safety, quality of care, and outcomes.345678910 Computerized physician order entry (CPOE) accelerates the delivery of care, improves efficiency, and reduces the number of professionals in the clinical workflow, decreasing delays, adverse events, and errors arising from illegible handwriting and miscommunication. Electronic health records, CPOE with clinical decision support, and digital documentation reduce unintended acts of omission or commission, errors of execution or planning, and deviations from standard care; they also distribute and ensure the practice of evidence based medicine.

Reduced medical errors

A systematic review of 50 studies found CPOE in hospitals reduced medical errors and adverse drug events, especially when bundled with clinical decision support that alerts providers to laboratory or medical errors.3 Meta-analysis of 16 studies found that compared with paper order entry, CPOE reduced preventable adverse drug events and drug errors by 50%.4 Analysis of 3364 hospitals found 269 facilities implementing CPOE outperformed comparison hospitals on five of 11 measures related to ordering drugs.5 Review of 22 studies found use of CPOE and clinical decision support in emergency departments was associated with significantly fewer prescribing errors (reduced by 17-201errors per 100 orders), potential adverse drug events (reduced by 0.9 per 100 orders), and prescribing of excessive doses (reduced by 31%).6 Eight studies on medical imaging services showed reduced unnecessary …

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