EHR usability issues linked to patient harm events

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Electronic health record usability issues are linked with potentially serious patient harm events, according to a new analysis conducted by MedStar Health.

The study, funded by the Agency for Healthcare Research and Quality, looks at some of the patient safety challenges of EHRs and potential ways to make improvements when it comes to their use.

Raj Ratwani, director of MedStar Health’s National Center for Human Factors in Healthcare, and his colleagues analyzed patient safety reports from 2013 to 2016 from 571 medical facilities in Pennsylvania and from a large, mid-Atlantic multihospital academic health system.

Their research, published Tuesday in the Journal of the American Medical Association, focused on safety reports explicitly mentioning the top five EHR vendors (by market share) as well as possible patient harm.

“The high-level point from the article is that some EHRs suffer from poor usability—or suboptimal usability—and what we’re finding here is that this poor usability can be associated with patient harm events,” says Ratwani. “We’re raising awareness around some of these specific challenges. We see these data as being actionable.”

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Of more than 1.7 million reported safety events, 1,956 (0.11%) explicitly mentioned an EHR vendor or product and were reported as possible patient harm, and 557 (0.03%) had language explicitly suggesting EHR usability contributed to possible patient harm.

Ratwani contends that some observers might point to the 557 patient harm events related to EHR usability and conclude that it’s not a critically important area, given the small percentage it represents of all safety events. However, he believes that would be the wrong conclusion to draw from the data.

“Only a small percentage of potential harm events were associated with EHR usability, but the analysis was conservative because safety reports only capture a small fraction of the actual number of safety incidents, and only reports with explicit mentions of the top five vendors or products were included,” states the study.

The authors identified patient harm scenarios involving seven categories of usability: alerting, availability of information, data entry, interoperability, system automation and defaults, visual display, and workflow support. In addition, they found that usability challenges were associated with four types of clinical processes: documentation, medication administration, order placement and review of results.

“Of the seven usability categories, challenges were data entry (27%, n = 152), alerting (22%, n = 122), interoperability (18%, n = 102), visual display (9%, n = 52), availability of information (9%, n = 50), system automation and defaults (8%, n = 43), and workflow support (7%, n = 36),” according to the article. “Of the four EHR clinical processes, usability challenges occurred during order placement (38%, n = 213), medication administration (37%, n = 207), review of results (16%, n = 87), and documentation (9%, n = 50).”

Ratwani points out that three usability categories—data entry, alerting and interoperability—account for almost 60 percent of the issues that researchers identified. To address these usability challenges, he and his colleagues call for greater collaboration among all stakeholders including EHR vendors and providers, as well as a reexamination of federal policies.

“There’s no question that electronic health records have clear benefits for clinicians and patients, and can improve the care process. However, nearly all healthcare systems have adopted an EHR, and this technology has introduced some new risks to patient safety, as our study has shown,” concludes Ratwani. “Our view is that even one patient harm event that stems from EHR usability issues is unacceptable. These are solvable issues, and we are committed to improving EHR usability and patient safety.”

The National Center for Human Factors in Healthcare conducts safety science and applied research in medicine to improve safety, quality, efficiency and reliability. MedStar Health is the largest not-for-profit provider in the Maryland and Washington, D.C., area, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.

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