Usability issues and variations in implementation create fears of unnecessary patient harm.
To find out what impact electronic health record (EHR) usability had on patient outcomes, a team from MedStar health drilled into patient safety reports from the Pennsylvania Patient Safety Authority database and another large health system outside of the state. Between 2013 and 2016, they found nearly 2,000 cases where specific EHR systems or vendors were explicitly reported as a possible cause of patient harm. Another 557 cases pointed to EHR usability as a contributing factor.
That may sound bad, but the researchers looked at over 1.7 million reports in total: EHRs came up less than 0.15% of the time. How much EHR-related harm is too much?
“We should not be tolerating anything that's going to cause harm,” lead author Raj M. Ratwani, PhD, told The American Journal of Managed Care (which is a sister publication of Healthcare Analytics News™).
And the numbers his team found are probably understated: They took a “very, very conservative approach” to analyzing the data. Prevalence would likely be higher, Ratwani said, if the study was scaled across all 50 states; if it didn’t only include occasions when the EHR system or vendor was mentioned by name; and if patient safety incidents were reported at the rate they actually occur. The researcher says there’s probably 5 or 10 times more events than show up in databases.
The top usability factors blamed for the incidents were common gripes that clinicians have with their EHR systems: data entry (27% of cases), alerting (22%), and interoperability (18%) were the top 3, while visual display, availability of information, system automation and defaults, and workflow accounted, in nearly equal part, for the rest. The study was published this week in JAMA.
Those who use the systems on a day-to-day basis consistently express concern about potential harm they may bring. While many physicians complain about the technology no matter their vendor or how long they’ve used it, adjusting to new systems can create particular anguish. Politico, for example, recently reported on a usability issues during a new EHR implementation at Department of Defense facilities, writing that “some clinicians quit because they were terrified they would hurt patients, or even kill them.”
In a Canadian health system that recently switched to that same vendor, a majority of front-line staff reported that the EHR decreased the likelihood of safe patient outcomes. More than a quarter (26%) said it did so “significantly.” Combined, only 23% said the system “somewhat” or “significantly” increased the likelihood of a safe outcome.
“We really need to focus on the variability that's occurring during implementation and ensuring that vendors and providers are working together to address these challenges,” Ratwani said. He echoed many in the industry, calling for vendors and providers to work more closely together in developing and implementing systems that avoid usability concerns.