We are running the executable (V10 SP2.5.48). There is a huge patient safety issue where changes/additions to the Medical History are not saved. This happens in at least two extremely common and reproducible instances:
1) When you click on an existing line of the patient history to edit, edit the text, and then click on the white space below the last medical history line (see picture) to exit editing the line, the changes you made to the line show up on the Medical History popup, but do not save when you go back to the Progress Note.
2) When you click “Add” and add a line of Medical History, and then click on the blank space below the last medical history line you just added (see picture) to exit editing, the line you just added shows up on the Medical History popup, but is not saved when you go back to the progress note.
Example:
- Open a patient’s progress note
- Click “Medical History”
- Click “Add” to add a new condition or edit an existing line
- Type some important medical condition that you want saved to keep your patient alive “Severe unstable angina”
- Click anywhere in the white space below the the last medical history line (see picture) to finish your addition/edit
- Click the red X in the upper right to go back to the Progress Note
- Watch as nothing happens and your medical history change is lost
This is probably the scariest thing I’ve seen with eCW. I’m pretty sure I’ve noticed the effects of this for years, because I’ve had assistants tell me that they added something to the medical history or changed a line, but it wasn’t there when I reviewed it. However, I was only able to figure out how to reproduce it recently. How much crucial information has been lost, and how much patient harm has this caused?
Having a computer science degree myself before my dental degree, I’d consider bugs like this indefensible. Clicking away from the cell you are editing in a spreadsheet program to save the changes you just made is common user behavior (this is my behavior almost 100% of the time to make sure my change got saved). The white area below the medical conditions is one of the most logical places to click to prevent you from editing another line. The fact that the change registers in the popup also indicates to the user that the it was acknowledged. To have it then fail to save on the progress note is unbelievable.
My other concern regarding safety issues in general is the way in which they are tracked and processed. I tried to search for this issue on my.eclinicalworks.com, but the list of issues unnecessarily truncates the majority of the title of the issue (e.g. “Patient Safety Advisory: Browser Only - Global Alert Notes Information… NEW”) while leaving empty space to the right of “NEW” where it could have finished the title. It doesn’t even display the full title when you hover over it. Even more incredibly, the search function doesn’t actually search the full title or body of the issue, it only searches the truncated title! Finally, to have significant issues sit around on that list for months with the proposed solution “Don’t trigger the bug” and the status “We’re working diligently on it” is very concerning.
I’m posting this here for a few reasons:
- To see if others can confirm what other versions have the same issue
- To make others aware of the issue
- I don’t have privileges to initiate cases from my.eclinicalworks.com
- When I report something over the phone, I’m either told that it is expected behavior or a known issue that is fixed in the browser version
- Our SAM usually monitors the forum
- I’d like to know (preferably from Girish) how things like this happen
Am I overreacting? Isn’t there some significant oversight on eCW due to the settlement and previous safety issues? Obviously the handling of current patient safety issues isn’t working, so what can we do? The integrity of medical records, particular medical histories, should be the number one priority of an EHR. If my PCP used eCW, I would absolutely find a new office, no matter how good he/she was.