How to Use Electronic Health Records to Achieve the Quadruple Aim

摘要

I applaud the Research Letter by Quinn et al. It provides a welcome counterpoint to previous reports raising fears that electronic health records (EHRs) may result in increased errors and patient injury. My colleagues at Princeton Insurance Company and I undertook a comprehensive study to determine what care gaps most often associated with litigation could be minimized by the appropriate use of EHRs and their safety-enhancing functionalities. We analyzed 7000 closed and open claims over a 6-year period at Princeton Insurance Company. The Harvard Risk Management Foundation provided coding books and trained abstractors to identify hundreds of potential care gaps associated with these lawsuits. These care gaps were grouped into 4 broad categories of errors that could be addressed by the appropriate use of EHRs: clinical judgment errors; communication gaps (between physicians and patients and between physicians and other health care providers); documentation discrepancies (as to the mechanics and sufficiency of documentation); and office systems deficiencies (concerning tracking of patients' tests ordered, results, and follow-up).