Electronic Health Records: Adoption and Patient Safety

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Electronic Health Records: Adoption and Patient Safety

Healthcare Organization and Management · Chapter 10: Health Informatics and Technology ManagementSection 10.3 · lesson 61 of 10511 min · free with a free account

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In this lesson

How electronic health records improve safety and create new risks.

  • Distinguish electronic medical, electronic health, and personal health records
  • Explain how computerized provider order entry and decision support affect safety
  • Identify EHR safety risks such as copy-forward and wrong-patient entries
  • Summarize how federal programs drove EHR adoption

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Transcript

Everything said in the video, section by section (1,435 words). Read along, or search it.

Opening Case

Eleven Days of Copied Notes

On one Larkfield unit, a patient's record said the same thing for eleven straight days: walks independently. It had stopped being true a week earlier. A decision was made on that line, and had to be reversed. Four different nurses signed those notes. Were four people careless? Or did the record itself make copying the easiest path?

Record Types

EMR, EHR, and PHR

First, three records that people treat as the same thing. An electronic medical record is the digital chart of one organization. An electronic health record is designed to follow the patient, with information from more than one care setting. A personal health record is one the patient controls, adds to, and grants access to. Its contents aren't verified by the hospital, which matters when using them clinically. Call a medical record a health record, and you'll keep being surprised that other providers' information is missing.

EHR Functions

Six Jobs a Record Does

An EHR does six main jobs. Documentation captures the encounter: history, findings, assessment, and plan. Order entry sends a clinician's request to the department that will carry it out. Results management receives what comes back, and tracks whether it was seen and acted on. Clinical decision support supplies information at the moment of decision. Patient access opens part of the record to the patient. And reporting pulls data out for quality measures, regulators, billing, and management. Each job is also a place where work gets created. That's why the record is both the hospital's biggest safety asset, and its biggest source of documentation burden.

Order Entry

Errors Removed by Design

Take order entry. Computerized provider order entry means the responsible clinician enters the order directly, with nobody transcribing it. Its safety value is structural. No handwriting, so nothing is misread. No transcription, so nothing changes in copying. The order must be complete before it's sent. And it's timestamped and attributed. Those errors are removed by design, not by anyone's vigilance, which is why the gain lasts. But it does nothing about an order that's complete, legible, attributed, and wrong. And picking the item next to the right one, in a dropdown list, is a new error paper never had.

Decision Support

Four Kinds of Clinical Decision Support

Clinical decision support is anything that presents information to improve a decision as it's made. Four kinds cover most of it. Alerts interrupt when a condition is detected. Order sets group items usually ordered together, making the standard approach the default. Reminders flag something due, usually without blocking. Reference puts guidance in context. Good support arrives at the moment of decision, fits this patient, and makes the right action easy, ideally on the same screen. And its intrusiveness should match the stakes. An interruptive alert is a scarce resource. Spend it on minor issues, and every other alert loses value.

Three Design Options

Hard Stops, Information, or Defaults

The same clinical risk can be handled three ways from one threshold decision. Block the task with a hard stop. Show information without blocking. Or build the safer choice into the default order set, so no alert is needed at all. Only the first spends clinician attention. Hospitals that reach for it by default use up the very resource that makes it work.

Quick Check

Building the Kidney Test Into Orders

Quick check. Patients starting a certain medicine need a kidney function test first. Clinicians often forget to order it. Which design spends the least clinician attention? Pause, and decide. The test built into the default order set. It's ordered unless someone deliberately removes it, so nobody is interrupted at all. The hard stop is tempting, because it guarantees the test. But it interrupts every order, and teaches people to click past interruptions.

Patient Portals

Release Timing and Information Blocking

A patient portal lets patients view part of their record, book visits, and message their team. It changes more than it adds. Notes are now written knowing the patient will read them. Results can reach patients before the clinician has reviewed them, so the hospital has to decide its release timing on purpose. Since the 21st Century Cures Act of 2016, information blocking is barred. Holding back electronic information needs a recognized exception, such as preventing harm, privacy, or security. Messaging creates demand with no natural limit and no owner. And a portal can widen gaps for patients without a device or connection, so make it an extra route, never the only one.

Data for Reporting

Fields That Exist to Be Counted

Much of what the record collects exists to be counted, not to help the visit. Quality indicators, regulators, and payment programs need structured, complete data, captured at the point of care. That's a real benefit, paid for in clinicians' minutes. So read any indicator built on a field filled in a hurry with that in mind. And make each required field renewable. A field justified by a reporting rule that has lapsed keeps costing time every day, until someone asks.

Record Safety Risks

Copy-Forward and Wrong-Patient Entries

The record also brings its own safety risks. Copy-forward reuses earlier text in a new entry. It saves time, and also spreads errors, bloats the record, and hides what was actually assessed today. The risk isn't that someone copied. It's that copying is the fastest route to a complete-looking note, and nobody has said what must be entered fresh. Wrong-patient selection, entering data in another patient's record, follows from similar names, open records, and interruptions. It's fixed by design: identity on every screen, verification prompts, limits on open records. And there's false reassurance from a completed field. A finished risk assessment proves the form was finished. Managers who read completion rates as performance are measuring the form.

Adoption History

HITECH, Meaningful Use, and Promoting Interoperability

How did records spread so fast? The federal health IT office reports that in 2008, just 9 percent of hospitals had even a basic electronic record. In 2009, the HITECH Act set out to expand health IT. From 2011, Medicare and Medicaid paid incentives for meaningful use of certified records. Later, hospitals that didn't qualify faced Medicare payment reductions. In April 2018, the programs were renamed Promoting Interoperability, shifting the focus to exchange and patient access. By 2024, over 99 percent of acute care hospitals, and 91 percent of office-based physicians, had a certified record. Reporting rules, mergers, and patient expectations pushed too.

The Evidence

Where Benefits Are Clearest

So what does the evidence say? Both the enthusiastic and the dismissive versions are wrong. Benefits are clearest where the mechanism is structural. Legibility. The record available in several places at once. No transcription. And the power to find every patient who meets a defined criterion. Results are mixed where they depend on how the system was built and used: overall error rates, efficiency, and clinical outcomes. Studies vary widely, and often disagree. The fair summary: the record is a necessary platform whose value depends on what the organization does with it. When someone claims a benefit, ask which domain they mean.

Ongoing Optimization

Four Department Measures to Watch

That's why optimization never ends. It means adjusting the live system to fit the work: rebuilding screens, retiring alerts that don't earn their interruption, and removing fields whose reason has lapsed. A manager supplies ranked local problems, and protects the staff time to specify them well. Four department measures show whether it's helping: time in the system per unit of work, override rates on local alerts, the results backlog's size and age, and the count of active workarounds. None is conclusive alone. Together, they're far more telling than a satisfaction score.

Quick Check

A Patient-Kept Blood Sugar Log

Quick check. A patient logs her own blood sugar readings in an app, and chooses to share them with her Larkfield clinic. Which kind of record is that? Pause, and decide. A personal health record. She controls it, she enters the data, and she grants access. So the clinic should treat the readings as unverified until checked. Electronic health record is tempting, because the data reaches a clinic. But an EHR is kept by care providers, not by the patient.

Case Resolved

Marking Carried-Forward Text

Back to the eleven stale notes. The unit's manager treats the individual signatures as real, but as the smaller finding. Four people failing the same way isn't four coincidences. She finds the conditions. The note template has nineteen required items, and about two change from day to day. One click copies the whole previous note, with nothing marking what was carried over. And the unit's unwritten rule says every daily note addresses every item. Under time pressure, copying everything was the only achievable behavior. So she asks informatics to mark carried-forward text, and writes a rule naming what must be entered fresh daily. Some notes will look less complete. She'd rather read a short note written today.

Key Takeaways

Whose Record, Which Benefit

To recap. EMR, EHR, or PHR: ask whose record it is. Order entry removes some errors by design, and adds new ones. Spend interruptions sparingly. Defaults and order sets cost no attention. Watch for copy-forward, wrong-patient entries, and completed forms that prove nothing. And benefits are clearest where the mechanism is structural.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

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Why students take Healthcare Organization and Management with UPI Study

How hospitals and clinics are runHealthcare Organization and Management covers how care organizations are led and run: health law and ethics, leadership and teams, strategic planning, health informatics, budgets, quality improvement, staffing and marketing. It is a core course in healthcare administration and health management degrees.
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130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Electronic Health Records: Adoption and Patient Safety

What is the difference between an EMR, an EHR, and a PHR?
An electronic medical record is one organization's digital chart. An electronic health record is designed to follow the patient, combining information from more than one care setting. A personal health record is controlled by the patient, who adds to it and grants access, so its contents are not verified by the provider and should be checked before clinical use.
How does computerized provider order entry improve patient safety?
With computerized provider order entry, the responsible clinician enters orders directly, so there is no handwriting to misread and no transcription step to introduce changes. Orders must be complete before sending and are timestamped and attributed, so those errors are removed by design. It does not catch an order that is complete and wrong, and it adds a new risk: picking the wrong item from a dropdown list.
What did the HITECH Act do for electronic health records?
The HITECH Act of 2009 set out to expand health information technology. Starting in 2011, Medicare and Medicaid paid incentives for meaningful use of certified electronic records, and hospitals that did not qualify later faced Medicare payment reductions. In 2018 the programs were renamed Promoting Interoperability, shifting focus toward information exchange and patient access. In 2008, only about 9 percent of hospitals had even a basic electronic record.
Why is copy-forward documentation a patient safety risk?
Copy-forward reuses earlier text in a new note. It saves time, but it can spread outdated information, bloat the record, and hide what was actually assessed that day, such as a mobility status that stopped being true. The underlying problem is usually design, because copying becomes the fastest path to a complete-looking note. Marking carried-forward text and naming what must be entered fresh helps.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Healthcare Organization and Management.

105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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