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Showing results for tags 'Electronic Health Record'.
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Content ArticleThe importance of big health data is recognised worldwide. Most UK National Health Service (NHS) care interactions are recorded in electronic health records, resulting in an unmatched potential for population-level datasets. However, policy reviews have highlighted challenges from a complex data-sharing landscape relating to transparency, privacy, and analysis capabilities. In response, authors of this study, published in The Lancet Digital Health, used public information sources to map all electronic patient data flows across England, from providers to more than 460 subsequent academic, commercial, and public data consumers. Although NHS data support a global research ecosystem, they found that multistage data flow chains limit transparency and risk public trust, most data interactions do not fulfil recommended best practices for safe data access, and existing infrastructure produces aggregation of duplicate data assets, thus limiting diversity of data and added value to end users. They provide recommendations to support data infrastructure transformation and have produced a website to promote transparency and showcase NHS data assets.
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News ArticleA trust saw nearly 1,000 safety reports filed after introducing a new electronic patient record (EPR) – including one where a patient died and 30 others where they suffered harm. The Royal Surrey Foundation Trust and Ashford and St Peter’s Hospital Foundation Trust installed a new joint EPR system in the middle of last year. But Royal Surrey’s board was told there had been 927 Datix reports — which are used to raise safety concerns — related to the introduction of the “Surrey Safe Care” system, running up until mid September this year. The catastrophic harm involved a patient death which the trust says was not “directly linked to technical problems” with the EPR, as “human factors” were involved, including inexperience or unfamiliarity with the electronic prescribing system. Louise Stead, chief executive of Royal Surrey, said: “Implementing an electronic patient record is a huge shift for any workforce and we experienced some issues with the functionality of the system and getting users sufficiently trained and confident in using it correctly. We have worked hard to address these issues as quickly and responsibly as possible. “Our fundamental aim is for ‘zero harm’ and any harm caused to a patient is taken extremely seriously and investigated. In the case of these Datix incidents the vast majority (over 99%) resulted in low or no harm to patients. “However, one case resulted in the tragic death of a patient and we have been working closely with their family to be transparent and learn every possible lesson. This case was not directly linked to technical problems with the electronic patient record system and human factors did contribute. We are sincerely sorry for the failure in their care and devastating impact upon this person’s family.” Read full story (paywalled) Source: HSJ, 11 October 2023
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News Article
‘Staggering’ paper use revealed as NHS told electronic records safer
Patient Safety Learning posted a news article in News
The NHS still relies heavily on paper notes, with experts warning they are not as safe or efficient as electronic records. It comes after a survey by the British Medical Journal (BMJ) found the majority of NHS trusts are still using paper, despite 88% of all trusts in England being equipped with electronic patient record (EPR) systems. Of 182 trusts, 4% said they only use paper notes, while 25% are fully electronic. Some 71% use both paper and an EPR system. Of the 172 trusts that responded to questions on prescriptions, 9% said they only use paper drug charts, 27% are fully electronic, and 64% use a mixture. Writing for the BMJ, freelance journalist and doctor Jo Best argued that the continued reliance on paper is less safe and efficient, while difficulties around sharing electronic records could be preventing even the most advanced trusts from realising their full potential. Read full story Source: The Independent, 14 September 2023 -
Content ArticleThis article published by the Betsy Lehman Center looks at the benefits of real-time monitoring of electronic health records (EHRs). Early adopter hospitals have demonstrated dramatic gains in safety by monitoring patients' EHR's in real time for signals of potential safety events, allowing providers to more quickly and effectively address safety gaps and improve outcomes. This monitoring is carried out by automated safety surveillance software that continuously runs in the background of EHR systems and can detect hundreds of categories of adverse events as they occur. Expert analysis then quickly helps organisations gain insight from the data, which can be used to proactively reduce safety risks and reliably measure incidence of harm over time.
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News Article
24,000 hospital letters lost in computer error
Patient Safety Learning posted a news article in News
A hospital trust failed to send out 24,000 letters from senior doctors to patients and their GPs after they became lost in a new computer system, the BBC has learned. Newcastle Hospitals warned the problem, dating back to 2018, is significant. The BBC has been told the problems occurred when letters requiring sign-off from a senior doctor were placed into a folder few staff knew existed. The healthcare regulator has sought urgent assurances over patient safety. Most of the letters explain what should happen when patients are discharged from hospital. But a significant number of the unsent letters are written by specialist clinics spelling out care that is needed for patients. It means that some crucial tests and results may have been missed by patients. Staff have been told to record any resulting incidents of patient harm and ensure these are addressed. Following a routine inspection by the regulator - the Care Quality Commission (CQC) - in the summer, staff at the trust raised concerns about delays in sending out correspondence. A subsequent review of the trust's consultants revealed that most had unsent letters in their electronic records. Read full story Source: BBC News, 26 September 2023 -
Content ArticleRecent polling from Healthwatch England shows that a fifth of patients referred by a GP for consultant-led care end up in a ‘referral black hole’, with more than two million patients each year having to make four or more visits to their GP before a referral is accepted. The result is that tens of thousands of patients could be on a ‘hidden’ waiting list, meaning that GPs are managing greater clinical risk and a greater number of patients whose conditions are often worsening in primary care, whilst communication between providers and access to diagnostics are often not up to scratch. This report by the think tank Policy Exchange looks at reforms that could be made to the interface between primary and secondary care in order to improve care and prevent patient harm. It considers how improved flows of information and expertise can: better support growing demand in general practice reduce unwarranted variation in service provision enhance care coordination – particularly for those referred for elective procedures enable opportunities to boost generalist medical skills for a new generation of doctors create opportunities for hospital specialists to deliver a greater proportion of care in primary or community care settings, reducing waiting times and the use of more expensive settings for care.
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Content ArticlePatients and families are key partners in diagnosis, but there are few methods to routinely engage them in diagnostic safety. Policy mandating patient access to electronic health information presents new opportunities, and in this study, researchers tested a new online tool—OurDX—that was codesigned with patients and families. The study aimed to determine the types and frequencies of potential safety issues identified by patients with chronic health conditions and their families and whether their contributions were integrated into the visit note. The results showed that probable Diagnostic Safety Opportunities (DSOs) were identified by 7.5% of paediatric and adult patients with underlying health conditions or their families. Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. The most common types of DSOs were patients or families not feeling heard, problems or delays with tests or referrals and problems or delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. The researchers concluded that OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients and families identified DSOs and most of their OurDX contributions were included in the visit note.
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Content ArticleThe SAFER Guides are designed to help healthcare organisations conduct self-assessments to optimise the safety and safe use of electronic health records (EHRs). Each of the nine SAFER Guides begins with a Checklist of “recommended practices.” This Patient Identification SAFER Guide identifies recommended safety practices associated with the reliable identification of patients in the EHRs. Accurate patient identification ensures that the information presented by and entered into the EHR is associated with the correct person. Processes related to patient identification are complex and require careful planning and attention to avoid errors. The SAFER Guides are produced by The Office of The National Coordinator for Health Information Technology.
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Content ArticleThis toolkit provides information about how the US Department of Health and Human Services Office of the Director General conducted recent medical record reviews to identify patient harm. It outlines the decision criteria for adverse events and describes the methods used in the report, 'Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm' in October 2018, building upon a broader series of reports about adverse events in hospitals and other health care settings.
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News Article
Javid sets new target for trust digitisation
Patient Safety Learning posted a news article in News
Electronic patient record (EPR) systems must be implemented in at least 90% of NHS trusts by the end of next year, the health secretary has announced at HSJ’s Digital Transformation Summit. Speaking at the event with digital healthcare leaders in Birmingham, Mr Javid said an estimated one in five trusts are currently without EPR systems implemented. He said: “We have seen some brilliant progress {on digital transformation] but it’s not always been consistent across the board.” He said: “We must see these disparities as just as unjust as disparities in access to education and employment.” And added: “Electronic patient records are the essential prerequisite for a modern, digital NHS." Mr Javid said 40% of social care providers were grappling with entirely paper based records, and he also wanted them to all adopt electronic records. He also outlined the intended future of the NHS App, and the government’s ambition for this to be used by 75 per cent of adults in England by March 2024. Currently it is just over half of all adults. Mr Javid said he wanted the app to be the “future front door for interaction with the NHS”, and will be used by patients to directly communicate with their healthcare providers, to receive personalised health advice and to access test results. Read full story (paywalled) Source: HSJ, 24 February 2022 -
News ArticleVanderbilt University Medical Center is facing a federal civil rights investigation after turning the medical records of transgender patients over to Tennessee’s attorney general, hospital officials have confirmed. The U.S. Department of Health and Human Services’ investigation comes just weeks after two patients sued VUMC for releasing their records to Attorney General Jonathan Skrmetti late last year. “We have been contacted by and are working with the Office of Civil Rights,” spokesperson John Howser said in a statement late Thursday. “We have no further comment since this is an ongoing investigation.” VUMC has come under fire for waiting months before telling patients in June that their medical information was shared late last year, acting only after the existence of the requests emerged as evidence in another court case. The news sparked alarm for many families living in the ruby red state where GOP lawmakers have sought to ban gender-affirming care for transgender youth and limit LGBTQ rights. The patients suing over the release of their information say VUMC should have removed personally identifying information before turning over the records because the hospital was aware of Tennessee authorities’ hostile attitude toward the rights of transgender people. Many of the patients who had their private medical information shared with Skrmetti’s office are state workers, or their adult children or spouses; others are on TennCare, the state’s Medicaid plan. Some were not even patients at VUMC’s clinic that provides transgender care. “The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are,” said attorney Tricia Herzfeld, who is representing the patients. “Our clients are encouraged that the federal government is looking into what happened here.” Read full story Source: NBC News, 10 August 2023
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News Article
Cyber attack takes out two trusts’ records access
Patient Safety Learning posted a news article in News
Two ambulance trusts have been left without a working electronic patient care record system for a week after a cyber attack affecting its Swedish-based supplier. Staff at South Western Ambulance Service Foundation Trust and South Central Ambulance Service FT have been working on paper since the MobiMed system – supplied by the firm Ortivus – went down last Tuesday. More than 1,700 ambulances and clinical workstations use the system, according to the company. One employee told HSJ some staff were struggling with a paper-based system which meant they had less information on patients. ”We can’t do summary care record searches or see previous call information,” the staff member said. SWASFT sent a message to staff on Friday saying the system was likely to be down “for a prolonged period”. Read full story (paywalled) Source: HSJ, 25 July 2023 -
News Article
Digitising all trusts by 2025 ‘unachievable’ after £700m cut, government admits
Patient Safety Learning posted a news article in News
NHS England’s target for all trusts to have a working electronic patient record (EPR) system by March 2025 is now ‘unachievable’’ and a new date has been set a year later, government has admitted. A new report of the Infrastructure and Projects Authority – the government body which scrutinises and supports major projects – states: “Delivery confidence is [rated] red as a number of NHS trusts are reporting they are unlikely to be able to fully implement an electronic patient record by March 2025.” The document, published quietly last week, downgrades the rating from “amber” to “red” – and also reveals £700m was cut from the programme’s budget last year. The “frontline digitisation” programme was launched by government and NHSE in 2021 with the aim of getting all trusts to a minimum level of capability, including 90% to have an EPR of an acceptable standard by the end of 2023, and 100 per cent by March 2025. But the IPA report states that a revised business case is now being prepared to reflect a new “end date” of March 2026. Read full story (paywalled) Source: HSJ, 24 July 2023 -
News Article
NHS doctors' paperwork piles up after cyber-attack
Patient Safety Learning posted a news article in News
Doctors say it could take months to process mounting piles of medical paperwork caused by a continuing cyber-attack on an NHS supplier. One out-of-hours GP says patient care is being badly affected as staff enter a fourth week of taking care notes with pen and paper. The ransomware attack against software and services provider Advanced was first spotted on 4 August. The company says it may take another 12 weeks to get some services back online. Dr Fay Wilson, who manages an urgent-care centre in the West Midlands, says the main choke point for her team is with patient records. She said it could affect patient care "because we can't send notifications to GP practices, except by methods that don't work because they require a lot of manual handling, and we haven't got the staff to actually do the manual handling". Read full story Source: BBC News, 31 August 2022 -
News Article
Trusts warn of continued care delay as IT outage goes on
Patient Safety Learning posted a news article in News
Mental health trusts continue to suffer much disruption after a cyber attack left them unable to access their electronic patient records. Several trusts which use Advanced’s CareNotes EPR are grappling with the system being down, although the company said on Friday some progress had been made to restore the EPR. One source at an affected mental health trust said there had been “not much in the way of improvements”, while another said they feared it could be “months” before they can fully access the EPR. NHS England’s mental health director Claire Murdoch is regularly raising issue nationally, HSJ was told, as response teams work with Advanced to investigate and restore IT systems, which were taken offline after the company was hit by a cyber attack two weeks ago. Hereford and Worcestershire Health and Care Trust has told its patients they might have to “provide more detail on your medical history to ensure clinicians have the most up-to-date information”, while Oxford Health Foundation Trust warned the technical issues could cause delays to patient care. Read full story (paywalled) Source: HSJ, 21 August 2022 -
News ArticleCriminals have issued ‘demands’ to an NHS IT supplier targeted by a cyber attack, leading health chiefs to fear they have accessed confidential patient data, HSJ has learned. IT firm Advanced was targeted last week. The company provides electronic patient records to several trusts and most NHS 111 providers. Multiple government agencies – including the National Crime Agency and GCHQ – are now working to identify the extent of the damage caused by the attackers, while leaders of affected mental health trusts have warned of a “pretty desperate” situation as staff are unable to access vital patient records. In a statement issued last night, Advanced said: “With respect to potentially impacted data, our investigation is under way, and when we have more information about potential data access or exfiltration, we will update customers as appropriate.” Read full story (paywalled) Source HSJ, 11 August 2022
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News Article
Cyber attack: NHS staff unable to access patient notes for three weeks
Patient Safety Learning posted a news article in News
A cyber attack that has caused a major outage of NHS IT systems is expected to last for more than three weeks, leaving doctors unable to see patients’ notes, The Independent has learned. Mental health trusts across the country will be left unable to access patient notes for weeks, and possibly months. Oxford Health Foundation Trust has declared a critical incident over the outage, which is believed to affect dozens of trusts, and has told staff it is putting emergency plans in place. One NHS trust chief said the situation could possibly last for “months” with several mental health trusts, and there was concern among leaders that the problem is not being prioritised. In an email to staff, Oxford Health Foundation Trust chief executive Nick Broughton, said: “The cyber attack targeted systems used to refer patients for care, including ambulances being dispatched, out-of-hours appointment bookings, triage, out-of-hours care, emergency prescriptions and safety alerts. It also targeted the finance system used by the Trust." The NHS director said: “The whole thing is down. It’s really alarming…we’re carrying a lot of risk as a result of it because you can’t get records and details of assessments, prescribing, key observations, medical mental health act observations. You can’t see any of it…Staff are going to have to write everything down and input it later.” They added: “There is increased risk to patients. We’re finding hard to discharge people, for example to housing providers, because we can’t access records.” Read full story Source: The Independent, 11 August 2022 -
News Article
NHS told to make better use of hospital passports to support patients
Patient Safety Learning posted a news article in News
Hospital passports need to be more consistently used across the NHS to better support patients with communication difficulties, a learning disability nurse says. Support for patients with communication needs and learning disabilities, as well as the nurses caring for them, is often ‘inconsistent’, according to RCN professional lead for learning disabilities Jonathan Beebee. Coupled with the current system-wide pressure of patient backlogs and high staff vacancy rates it means patients often do not have their communication needs met. A hospital passport, which contains vital information about a patient’s health condition, learning disability and communication needs, would help address this, Mr Beebee told Nursing Standard. "There has got to be better consistency in how we are identifying people with communication needs, how they are getting flagged and how nurses are being pointed to that from the second that someone is admitted to the ward," he said. Mr Beebee says ensuring a standardised approach would improve patient experience and ultimately nurses’ relationship with patients. Read full story Source: Nursing Standard, 27 July 2022 -
News Article
Hospital in meltdown over IT issues
Patient Safety Learning posted a news article in News
A whistleblower has warned a London hospital is "literally in meltdown" after its IT system was knocked out during last week's heatwave. Operations at Guy's and St Thomas' Hospital in Lambeth were cancelled after its IT servers broke down in 40C (104F) temperatures on 19 July. A doctor told the BBC "poor planning" and "chronic underfunding" meant issues remained a week later. A spokesperson for the hospital said IT issues were "having an ongoing impact". Without a functioning IT system, staff have returned to paper notes, the doctor said. The anonymous whistleblower, who works as a doctor at Guy's and St Thomas', said this meant "we see very worrying results, but we don't know where the patients are so we spend ages tracking them down". "We cannot read any historical notes from patients. Names are being misspelt, so scans are not showing up. "Each morning, someone hand-delivers a stack of test results to the ward. In there, we received several patient results that don't belong to our ward," the doctor said. "If we don't recover our shared drives, we risk losing months of research data, if not years." Read full story Source: BBC News, 27 July 2022 -
News Article
London NHS trust cancels operations as IT system fails in heatwave
Patient Safety Learning posted a news article in News
One of the NHS’s biggest hospital trusts is facing major problems after its IT system failed because of the extreme temperatures earlier this week. Guy’s and St Thomas’ trust (GSTT) in London has had to cancel operations, postpone appointments and divert seriously ill patients to other hospitals in the capital as a result of its IT meltdown. The situation means that doctors cannot see patients’ medical notes remotely and are having to write down the results of all examinations by hand. They are also unable to remotely access the results of diagnostic tests such as X-rays and CT and MRI scans and are instead having to call the imaging department, which is overloading the department’s telephone lines. GSTT has declared the problem a “critical site incident”. It has apologised to patients and asked them to bring letters or other paperwork about their condition with them to their appointment to help overcome doctors’ loss of access to their medical history. One doctor at GSTT, speaking on condition of anonymity, said: “This is having a major effect. We are back to using paper and can’t see any existing electronic notes. We are needing to triage basic tests like blood tests and scans. There’s no access to results apart from over the phone, and of course the whole hospital is trying to use that line. “Frankly, it’s a big patient safety issue and we haven’t been told how long it will take to fix. We are on divert for major specialist services such as cardiac, vascular and ECMO.” Read full story Source: The Guardian, 21 July 2022 -
News ArticleA new patient medical records system at a Spokane Veterans Affairs hospital in the US has caused nearly 150 cases of patient harm, according to a federal watchdog agency. An inspection by the VA Office of the Inspector General (OIG) found that a new Cerner electronic health record (EHR) system, now owned by Oracle, failed to deliver more than 11,000 orders for specialty care, lab work and other services at Mann-Grandstaff VA Medical Center, the first VA facility to roll out the new technology. The OIG review found that the new EHR sent thousands of orders for medical care to an undetectable location, or unknown queue, instead of the intended care or service location, effectively causing the orders to disappear without letting clinicians know they weren't delivered. The intent of the unknown queue is to capture orders entered by providers that the new EHR cannot deliver to the intended location because the orders were not recognized as a “match” by the system, according to the VA watchdog. From facility go-live in October 2020 through June 2021, the new EHR failed to deliver more than 11,000 orders for requested clinical services. Those lost orders, often called referrals, resulted in delayed care and what a VA patient safety team classified as dozens of cases of "moderate harm" and one case of "major harm." The clinical reviewers conducted 1,286 facility event assessments and identified and classified 149 adverse events for patients. Read full story Source: Fierce Healthcare, 20 July 2022
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News ArticlePatients are at risk of a missed cancer diagnosis due to a reliance on paper records, an NHS trust has admitted after a man died due to his tumour being overlooked. Michael Lane, 50, from Shrewsbury, was “failed” by Shrewsbury and Telford Hospital Trust, his family has said after his cancer scan result was misplaced leaving him with a growing kidney tumour for 10 years. The trust is yet to fully launch an electronic record system a year after an investigation into Mr Lane’s death warned other patients were at risk due to the gap in paper records. Mr Lane went into Shrewsbury and Telford Hospital for a scan following a referral for suspected cancer in 2011. The radiographer flagged a small tumour but the scan was overlooked, placed within his paper records and never reported as being a concern. In an investigation report carried out by the trust in May 2021, seen by The Independent, the hospital admitted that had his tumour been seen and operated on earlier he may have survived. The report also admitted there were ongoing risks within the trust due to gaps in its electronic records system. It said: “The implementation of an IT solution will not prevent sad cases such as that of Mr Lane where the scan report that was missed took place before the widespread availability of such systems, however, it is clear that until we have an electronic requesting and sign-off system we remain at risk of new cases of missed results and harm occurring as a result of the ongoing reliance of paper-based results.” Read full story Source: The Independent, 17 July 2022
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News Article
NHS App to get new digital features by 2023
Patient Safety Learning posted a news article in News
The NHS App will soon be updated with features to help offer people in England more personalised care. It is part of the government's plan for a digital revolution to speed up care and improve access while saving the health service time and money. By March 2023, more users will receive messages from their GP and be able to see their medical records and manage hospital elective-care appointments. By March 2024, the app should offer face-to-face video consultations. The government's ambition is for at least 75% of adults to be using it by March 2024. Currently, less than half - about 28 million - have it on their phone or tablet. The government also wants 90% of NHS trusts to have electronic patient records in place or be processing them by December 2023 and for all social-care providers to adopt a digital social-care record. And patients across the country should be able to complete their hospital pre-assessment checks from home by September 2024. Read full story Source: BBC News, 29 June 2022 -
News Article
USA: Cerner’s VA software rollout report cites 150 “cases of harm”
Patient Safety Learning posted a news article in News
A serious revelation may derail the Cerner Millenium rollout. A draft report by the Department of Veterans Affairs (VA) Office of Inspector General (OIG) states that a flaw in Cerner’s software caused the system to lose 11,000 orders for specialty care, lab work, and other services – without alerting healthcare providers the orders (also known as referrals) had been lost. This created ‘cases of harm’ to at least 150 veterans in care. The VA patient safety team classified dozens of cases of “moderate harm” and one case of “major harm.” The major harm cited affected a homeless veteran, aged in his 60s, who was identified as at risk for suicide and had seen a psychiatrist at Mann-Grandstaff in December 2020, after the implementation. After prescribing medication to treat depression, the psychiatrist ordered a follow-up appointment one month later. That order disappeared in the electronic health record and was not scheduled. The consequences were that the veteran, weeks after the unscheduled appointment date, called the Veterans Crisis Line. He was going to kill himself with a razor. Fortunately, he was found in time by local first responders, taken to a non-VA mental health unit, and hospitalized. The draft report implies that the ‘unknown queue’ problem has not been fixed and continues to put veterans at risk in the VA system. There may be as many as 60 other safety problems. Other incidents cited in the draft report include one of “catastrophic harm” and another case the VA told the OIG may be reclassified as catastrophic. Catastrophic harm is defined by the VA as “death or permanent loss of function.” Read full story Source: Telehealth and Telecare Aware, 21 June 2022 -
News Article
Trust branded ‘inadequate’ for leadership and maternity
Patient Safety Learning posted a news article in News
One of the trusts worst affected by coronavirus has been issued with two warning notices and rated ‘inadequate’ for leadership, following a Care Quality Commission inspection. The regulator raised serious concerns about the safety of Countess of Chester Hospital Foundation Trust’s maternity services, as well as the oversight and learning from incidents. It also found staff were experiencing multiple problems with a newly installed electronic patient record, while systems for managing the elective waiting list were said to be unsuitable. In maternity services, the inspectors flagged severe staff shortages and a failure to properly investigate safety incidents. They said there were three occasions during the inspections when the antenatal and post-natal ward was served by only one midwife, despite the interim head of midwifery saying this would never happen. Inspectors also highlighted five incidents last year where women had suffered a major post-partum haemorrhage, involving the loss of more than two litres of blood and which resulted in an unplanned hysterectomy. The CQC said two were not reported as serious incidents, and where learning had been identified from the others, action plans were not being completed on time. The CQC said it was only made aware of the incidents by a whistleblower, while internal actions agreed in December 2021 had still not been implemented two months later. Read full story (paywalled) Source: HSJ, 15 June 2022
