EHRs May Be Linked To Safety Problems Within Oncology Practices

A new study looking at safety in oncology settings has drawn a troubling conclusion — that the more clinicians in a group of oncology clinics relied on EHRs, the less likely they were to perform safety-related actions.

The study, which appeared in the Journal of Oncology Practice, investigated to what degree EHRs, satisfaction with technology and quality of clinician-to-clinician education support a safety culture within oncology groups.

To address this question, researchers measured actions typical of a safety culture, satisfaction with practice technology and quality of clinician communication among 297 oncology nurses and prescribers spread across 29 practices in the Michigan Oncology Quality Consortium. They also created an index which captured how reliant the practice was on their EHR.

The researchers found that 69% of respondents were satisfied with all paper records or paper and electronic records, while just 42% were satisfied with using only electronic records. Troublingly, they also found that clinicians whose practices had deployed the most sophisticated EHRs had lower safety scores and that greater reliance on EHRs was significantly associated with lower levels of safety actions across the board.

Among the problems, oncology clinicians faced with EHRs included situations in which physicians, nurses, and pharmacists got different patient information, a very dangerous situation considering the fact that they participate in administering potentially toxic chemotherapy drugs. Other issues included EHR presets which limit clinical notetaking capabilities or leave nurses and others on the patient care team with obsolete information on patients scheduled to receive chemotherapy.

From all of this, researchers drew the reasonable conclusion that it was high time oncology practices figure out how to use an EHR effectively.

“The inverse relationship between reliance on EHRs and safety suggest that technology may not facilitate clinicians ability to attend to patient safety,” they wrote. ”…Efforts to improve cancer care quality should focus on more seamless integration of EHRs into routine care delivery and emphasize increasing the capacity of all care clinicians to communicate effectively and coordinate efforts,” they wrote.

It’s worth noting that there is more at stake here than simply pumping up quality numbers.  “Chemo[therapy ] is a high-volume, high-risk endeavor and most patients receive these treatments in sectors like the ones we studied,”  said principal study author Christopher Friese, a University of Michigan nursing professor in an interview with Becker’s Hospital Review. ”Unlike some other treatments, there’s no reversal, there’s no antidote, we have to get it right the first time.”

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Is the EHR being used in the oncology practice one dedicated completely to oncology, i.e. Intellidose or Mosaiq, or have they adapted another EHR to fit their needs?

  • Hi Judith — Good question. My sense is that they were using general purpose EHRs. Let’s hope that oncology-specific platforms perform better than the ones described here!

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