EHR usability issues pose safety risk to pediatric patients

Electronic health record systems may present a significant risk to the health and safety of pediatric patients, especially when it comes to the administering of medications.

That’s the finding of a new study published in the journal Health Affairs based on the analysis of pediatric patient safety event reports, gathered from three healthcare systems, related to EHRs and medication.

Of 9,000 analyzed pediatric reports, 36 percent described a medication error that was related to EHR usability, and in 18.8 percent of cases, the error reached the patient—many of which might have resulted in harm—with the most common type of medication error being an overdose or underdose.

“Pediatric patients are uniquely vulnerable to EHR usability and safety challenges because of different physical characteristics, developmental issues and dependence on parents and other care providers to prevent medical errors,” states the study. “For example, lower body weight and less developed immune systems make pediatric patients less able to tolerate even small errors in medication dosing or delays in care that could be a result of EHR usability and safety issues.”

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Medical assistant Astrid Garcia, center, takes a patient's blood pressure at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S., on Wednesday, April 8, 2015. Led by the American Medical Association, three of the top five spenders on congressional lobbying have waged a campaign to urge Congress to revamp the way Medicare pays physicians and end the cycle of "doc fix" patches. Senate leaders predict quick action on House-passed legislation when Congress returns April 13 from its two-week recess. Photographer: Andrew Harrer/Bloomberg *** Local Caption *** Astrid Garcia

Also See: EHR usability issues linked to patient harm events

Specifically, the analysis of pediatric patient safety event reports by researchers found the following common EHR usability issues:

  • System feedback (82.4 percent), such as failure of a critical alert being triggered when an unusually large medication dose was ordered, or the system defaulting to a different date or time than ordered for administering the medication, resulting in a missed dose.
  • Visual display (9.7 percent), defined as confusing or cluttered information display.
  • Data entry (6.2 percent), defined as difficult or impossible entry of information.
  • Workflow support (1.7 percent), defined as a mismatch between the EHR workflow and expectations of the clinician.

The study, funded by the Agency for Healthcare Research and Quality and the Pew Charitable Trusts, was conducted by MedStar Health’s National Center for Human Factors in Healthcare in collaboration with Children’s Hospital of Philadelphia and Children’s Hospital of Wisconsin.

Researchers recommend that the Office of the National Coordinator for Health IT include safety as part of a pediatric-focused voluntary EHR certification program and that rigorous test-case scenarios based on realistic clinical tasks should be employed in all phases of EHR development and implementation.

“While there are many benefits to EHRs, usability is a recognized challenge and can have safety implications,” says Raj Ratwani, director of MedStar’s Human Factors Center and a lead researcher and author. “We sought to identify the specific types of EHR usability issues and associated medication errors in pediatric settings. These new findings reinforce precisely why it’s imperative for the ONC to act swiftly to ensure safety is part of the EHR voluntary certification program. One patient harmed is one too many, and we all have a heightened responsibility to protect all patients, especially children.”

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