Patient Safety Risks and Reminders Announced by eClinicalWorks

EHR vendor eClinicalWorks recently issued a periodic statement in order to remind eCW users about “potential patient safety risks” in the software. eClinicalWorks has previously released safety-related notices to their users reminding them to be aware of key patient safety risks and to focus on minimizing those risks by updating to the most recent version of the software.

“We periodically identify potential patient safety risks related to the use of our software,” the Westborough, Massachusetts-based vendor said in a statement dated Dec. 6.

According to eClinicalWorks, the use of any EHR carries risks related to some of the most complex functions performed by an EHR system such as medication management, electronic prescribing, and the ordering process for tests and procedures. And while eClinicalWorks has made a sustained effort to improve the eClinicalWorks EHR software while educating users on the proper use of the software to ensure patient safety, a number of reminders announced December 6th help further eClinicalWorks' commitment to minimize patient safety risks for their large base of users.

“As part of our ongoing effort to respond to and minimize such risks, eCW is making this announcement to ensure that all participants in the healthcare process – clinicians, pharmacies, and patients and their family members or caregivers – are aware of key patient safety risks and are focused on the roles they can play in minimizing those risks,” the statement continued.

Ensuring the safety of patients requires collaboration and communication between individuals, their physicians, others involved in healthcare delivery, and EHR companies.  With this in mind, we are issuing the following reminders:

Medication Management

The use of eCW’s EHR software carries with it risks related to medication management, electronic prescribing, and the ordering process for tests and procedures, which are among the most complex functions performed by any EHR system.

• In December 2015, for instance, in response to certain identified concerns, eCW advised users to install all software upgrades and patches and make adequate network resources available to allow the system to operate properly.  Prior to and since that time, eCW has issued other similar patient safety-related notices, all of which are available to eCW users at my.eclinicalworks.com.
• Consistent with our prior advisories, clinicians should continue to be vigilant about medication management, e-prescribing and the ordering of tests and procedures. Specifically, clinicians should review and adopt the measures outlined in both eCW’s December 2015 advisory and the other patient safety-related notices issued by eCW.  These measures include the following:

Upgrading to the Most Current Version of eCW's Software

In July 2016, the company directed all users to upgrade to the latest version of V10-SP1-C20.8 or higher to ensure that all changes designed to improve patient safety are implemented.  If you have not already done so, you should immediately install version V10-SP1-8 or higher, as well as all update patches. Failure to continually install updates may result in the software not receiving all necessary corrective fixes.

If you are a supported customer of GroupOne Health Source and have not yet completed the mandated version upgrade, please open a Help Desk case for your upgrade by calling our support line at 866-755-0746 or email helpdesk@g1hs.com.

Upgrade to the Most Current Version of the Multum or Medispan Drug Databases

eCW releases regular updates to commercial drug database information to ensure that the most current medication information is used. For cloud customers, this information is updated automatically; for non-cloud customers, the content update should be downloaded regularly.

• Designate a patient safety officer: As our previous advisories have made clear, every physician office should designate a patient safety officer to serve as the primary liaison with eCW on patient safety-related matters.
• Read every patient safety notice: Patient safety advisories and similar notices are an important way in which eCW communicates about potential risks to patient safety related to the use of our software. These notices explain the potential risk and recommend actions to mitigate the risk.  Providers should carefully read every patient safety notice, alert, or advisory that we issue and implement the recommended actions to ensure patient safety.  Again, eCW users can view a complete collection of these notices at my.elinicalworks.com.
• Confirm order accuracy: To avoid errors, providers should always confirm that prescriptions and orders created using eCW’s software are accurate.
• Encourage patients to confirm accuracy: You should ensure that your patients and their family members or caregivers are informed about medications, dosages, and other pertinent information about prescriptions and orders. Among other things, this should include encouraging them to obtain online patient portal accounts.  Additionally, you should instruct them to confirm that the correct medication has been dispensed by their pharmacists and that other types of orders have also been properly fulfilled.
• Follow correct steps for modifying medications: Rather than modifying an existing medication by changing the dosage or route, clinicians should discontinue the original medication and reorder it with the revised dosage or route.
• Exercise caution in the use of custom medications: Because the use of custom medications poses a higher risk of prescription errors, providers should limit their use whenever possible.  When custom medications are necessary, care should be taken to ensure that the prescriptions are properly transmitted and fulfilled.

Advice for Patients and their Family Members or Caregivers

Patients and their family members or caregivers should adopt the following safeguards:

• Be educated about your care: Ask your physician to give you or your caregiver access to eCW’s online patient portal, where you can review your visit summaries, medication orders and tests.
• Know your medications and orders: Be aware of the prescription medications (including names, dosages, and delivery methods) and the clinical, diagnostic, or other evaluative tests that have been ordered by your physician.
• Be sure to confirm accuracy: Confirm that the correct medication has been dispensed by your pharmacist and that tests are performed as ordered. 

Anyone – clinicians, prescribers, pharmacists, patients, caregivers, or others – who becomes aware of patient safety concerns or unexpected software issues should immediately report them to eCW at my.eclinicalworks.com and/or to the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology’s complaint website at www.healthit.gov/healthitcomplaints.