12 patient safety risks arising from EHR usability problems
To understand the scope of these problems, researchers from Pew worked with two children’s hospitals and one large mid-Atlantic healthcare system to identify and investigate incidents in which EHRs reportedly contributed to drug prescribing or administration errors that jeopardized safety for pediatric patients. These issues underscore the need for health information technology vendors, hospitals and clinicians to work together to design and implement EHRs, and to test them before and after deployment.
Examples of EHR usability-related medication safety events
• Information display: EHRs may display information in confusing ways, or data may be hard to find or missing.
• Difficult data entry: Challenges here may cause delays for orders and lead to clinician workarounds.
• System feedback: In some situations, EHRs may not communicate that an action has been taken, such as when a patient has already received a medication.
• Workflow support: Problems may arise when clinicians must share information or tasks with others.
Case 1: Inaccessible information leads to inappropriate drug administration
Case 2: Patient experiences a drug overdose because of an error in weight entry
Case 3: Poor information display contributes to a missed antibiotic dose
Case 4: Display problems with automatic medication holds cause missed dose
Case 5: Automated EHR function enters an Incorrect vaccine schedule
Case 6: A time change was associated with a missed organ rejection drug
Case 7: Hidden medication order settings contribute to a lapse in care
Case 8: An EHR fails to alert clinicians to a documented drug allergy
Case 9: Auto-verification of a medication contributes to administration delays
Case 10: A medication is discontinued automatically in the EHR
Case 11: Workarounds arising from EHR limitations cause problems
Case 12: Inability to adjust workflow holds up newborn care
How to correct these issues
ONC has an opportunity to address this discrepancy when implementing the 21st Century Cures Act. As part of regulations for the certification of EHRs used in the care of children, the agency could include safety-related requirements to reduce the likelihood that these types of errors occur. For example, ONC can encourage the testing of systems for safety by pediatricians and other clinicians who provide care to children.
Similarly, as EHR vendors and hospitals evaluate systems, new features, or site-specific customizations, they should use more robust and rigorous tests to detect and prevent safety-related challenges, such as after the implementation of systems in hospitals.