Early last week, the Department of Veterans Affairs found errors in some patients’ medical data that clinicians downloaded from the Defense network. While these errors were not linked to any adverse events, such errors are raising flags that software glitches could compromise the accuracy of electronic medical records. Further, such inaccuracies in patient records could have serious implications for the planned National Health Information Infrastructure.
The error was discovered when a VA physician accessed the Defense health records system to review a female patient’s prescription information. When the data showed that a Defense physician had prescribed her a completely inappropriate drug, the VA physician inquired about the prescription within the Defense medical facility. It was then determined that the patient’s data was wrong because the VA query had returned information for a different patient.
So, what caused this software glitch? In 2004, the VA and Defense Department collaborated to form a Bidirectional Health Information Exchange (BHIE), which allows clinicians in both departments to share and view patients’ electronic health data. Unfortunately, the system was built on older code, which could not keep up with the volume of physicians from both departments accessing patient data. At peak query times, the system didn’t clear out memory cache, which resulted in ‘memory leaks.’ In this case, information from one patient was presented as another.
Since the discovery of this glitch, access to the Defense Department’s EHR system has been closed. Fortunately, the VA has corrected the code error and will bring open access to the BHIE on March 9.
This issue brings up an important point: Health Information Exchanges must be carefully designed and monitored. Thankfully, this glitch was recognized by a VA physician, and it was corrected before any harm was done to a patient. While this error was recognized quickly because the prescription for the patient was blatantly inappropriate, other errors in digitized health data may not be so obvious, and systems should be in place to review and monitor data for accuracy within health information exchanges. Additionally, the coding and infrastructure must be robust enough to support the sharing of health information between multiple entities.
As the federal government has plans to create a National Health Information Infrastructure, lessons should be learned from errors that have occurred with smaller projects such as the BHIE to create the proper framework and monitoring for the health information highway of the future.