Study Finds Accuracy Gap in EHRs for Eye Care Patients

A patient’s electronic health record may not capture the most accurate, up-to-date information about ophthalmic medications, a new study finds.

11:00 AM

Author | Shelley Zalewski

When it comes to keeping track of prescribed medications between clinic visits, many patients rely on printed medication lists automatically generated from electronic health records (EHRs).

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

An examination of the EHRs of a cohort of ophthalmology patients revealed that one-third had at least one discrepancy between the medications discussed in the clinician's notes and those on the medication list.

These findings raise concerns about patient safety and continuity of care.

The study, published in JAMA Ophthalmology, was conducted by investigators at the University of Michigan Kellogg Eye Center. The team examined medication-related information contained in the EHRs of patients treated for microbial keratitis between July 2015 and August.

"Corneal infection is an important disease condition to study ophthalmic medication lists because the medications change rapidly," says cornea specialist Maria Woodward, M.S., M.D., assistant professor of ophthalmology and the study's lead author.

Often, many medications are used, some requiring compounding, making telephone orders to specialty pharmacies common.

"Because of the multiple clinic visits and frequent medication changes," Woodward says, "it is imperative to have strong verbal and written communication between providers and patients who are battling corneal infections."

SEE ALSO: A Switch to Generic Eye Drugs Could Save Medicare Millions Annually

In a typical appointment, a provider verbally communicates medication instructions to the patient. At the same time, notes from that discussion are typed into an unstructured or "free text" section of the patient's EHR by either the doctor, a technician or a medical scribe.

The patient then receives a medication list generated from the EHR as part of a printed after-visit summary.

"That summary should confirm how the provider intends medications to be used," says Woodward, also a health services researcher at the U-M Institute for Healthcare Policy and Innovation.

The team found that one-third of patients had at least one medication mismatch in their records.

While this is the first study focused on ophthalmic medications, the results are consistent with studies of medications used in other medical specialties.

"This level of inconsistency is a red flag," Woodward says. "Patients who rely on the after-visit summary may be at risk for avoidable medication errors that may affect their healing or experience medication toxicity."

Identifying the root cause

The switch to the EHR has led to many improvements in patient care. But as this study shows, it's not a perfect tool for the provider or the patient.

In a typical clinic visit, a prescription entered into the EHR triggers both an order to the patient's pharmacy and an update to the medication list.

SEE ALSO: Nearly 60% of Pinkeye Patients Receive Antibiotics. But They're Seldom Necessary.

But several scenarios can result in mismatches between the clinical notes and the medication list.

"Issues arise when a medication is started by an outside provider and continued at the new hospital and when patients require compounded medications that must be telephoned in to a pharmacist in the evening," Woodward says.

These scenarios expose a shortcoming of the EHR: Data about medications (and other information) is captured in multiple formats in multiple locations.

"The only way to ensure that the medication list is completely accurate is to double-document. The same information must be entered into the clinician's note and the formal medication list — two separate places," Woodward says.

"In a busy clinical setting, our top priority is communicating directly with the patient and answering their questions," she says. "We're focused on clarifying the treatment plan and addressing concerns, so duplicating note taking does not rise to our primary mission."

To improve both the reliability of medication information patients depend on and the accuracy of data used for research, Woodward's study team recommends that EHR developers create software solutions to ease the burden of clinical documentation and make it easier to reconcile medication names and dosages.


More Articles About: Industry DX Kellogg Eye Center Eye Care & Vision Health Care Delivery, Policy and Economics Hospitals & Centers Woodward Lab
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

In This Story
Maria (Mia) Woodward, MD Maria Anneke Woodward, MD, MSc

Associate Professor

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories 2025 blocks with stethoscope
Health Lab
Top 10 things to know about your health costs right now
Medicaid, Medicare, medical debt rules and Obamacare Marketplace insurance plans are being affected by actions by the Supreme Court, Congress and President Trump's administration
doctor close up listening to baby's heart while baby touches stethoscope while doctor smiles in doctor exam room on exam room table with medical equipment in background
Health Lab
Commentary: Employers are failing to insure the working class – Medicaid cuts will leave them even more vulnerable
A physician talks about what Medicaid cuts will impact Americans across the country.
gavel stethoscope
Health Lab
What does the Supreme Court's preventive care ruling mean for you?
The ruling in a court case called Kennedy vs. Braidwood relates to a popular Affordable Care Act provision
stethoscope close up black and wood table
Health Lab
Affordable Care Act preventive services mandate key to transforming hepatitis C treatment
In an article researchers describe two potential futures: one in which 90% of hepatitis C cases in the United States are cured within five years and another in which the status quo of insufficient screening rates worsen in the absence of the ACA coverage mandate.
outline drawing of pancreas on beige screen with green orange yellow and pink
Health Lab
Avoiding recovery delays with hospitalized pancreatitis
Acute pancreatitis is among the most common gastrointestinal conditions requiring inpatient hospital care in the United States. Balancing the signaling of the interleukin-22 protein and interleukin-22 binding protein is crucial to recovery from acute and chronic pancreatitis.
astronaut woman brushing tears away with astronaut glove and tear drops on the helment see through
Health Lab
How do spaceflights and long term planetary missions affect vision?
Joshua Ong, M.D., resident physician at University of Michigan Kellogg Eye Center answers questions about how spaceflight affects vision and what protective measures astronauts use.