User-unfriendly EHRs pose serious risks to patient safety
“Hospitals and healthcare systems have spent more than $100 billion on EHRs over the past decade, and most believe these systems are completely safe and useful, but that’s not necessarily the case,” says Dr. David Classen, professor of internal medicine at University of Utah Health
THE BIG TREND
Because of this inherent risk associated with poorly designed electronic health records, all hospitals “should perform an annual security audit on their system to ensure it is secure,” says Classen, whose EHR research has been published in the most recent edition of JAMA network opened.
Classen collaborated on the research project with the well-known innovation leader in the field of patient safety Dr. David Bates, from Brigham and Women’s Hospital, as well as scientists from University of California San Diego Health. Researchers from UC San Francisco and KLAS Enterprises also contributed.
He is not one to underestimate the magnitude of the problem. He said the situation is similar to software problems that led to two Boeing 737 MAX plane crashes in 2018 and 2019, with pilots’ struggle to get the software working exposing more fundamental safety issues.
The built-in safety mechanisms of EHRs need to be redesigned, the study suggests.
Classen argues that just as the Federal Aviation Administration, aviation manufacturers and airlines now jointly monitor and improve airline software, something similar should happen with EHR vendors, hospitals and physicians – who should work together to optimize EHR software for usability , provider experience and patient care. safety.
In inpatient settings, EHR alerts, reminders and clinical guidelines appear to guide physicians’ decision-making, the study notes. But it has long been known that these notifications are often more distracting than helpful.
Classen, Bates and their researchers studied EHR systems in 112 American hospitals, comparing a user experience survey of more than 5,000 physicians with the results of the Leapfrog CPOE Evaluation Toolwhich examines whether medication orders that could potentially harm a patient are actually detected by alert systems.
They found that user experience correlated strongly with EHR security: When users rated EHRs poorly, they said the systems were difficult to operate, difficult to learn, slow, or inefficient. When doctors encountered these problems, the software was less likely to flag drug interactions, drug allergies, duplicate orders, excessive dosing or other harmful medication errors, the study found.
One explanation could lie in a lack of quality control, Classen says, with individual hospitals customizing EHRs to meet their own organizational needs without keeping UI and UX at the forefront. But without usability standards, these changes and adjustments could come at the expense of safety, he said.
THE BIG TREND
As many as 400,000 people are injured every year due to medical errors in hospital, the study shows – and a major argument for the widespread adoption of EHRs more than a decade ago was that they could contribute to patient safety.
But previous research by Classen and Bates has shown that this is not always the case, such as a 2020 report that showed how electronic health records failed to reliably detect medical errors – including dangerous drug interactions – that could cause patient harm.
The safety risk of EHRs to hospital patients has long been debated and debated, with widespread recognition of the need for design optimization and a rethink of how they lead to less than ideal usage patterns.
ON THE RECORD
“Poor usability of EHRs is the number one complaint from doctors, nurses, pharmacists and most healthcare professionals,” Classen said. “This is linked to poor safety performance.” He added: “Our findings suggest that we need to improve EHR systems to make them both more user-friendly and more secure.”
Mike Miliard is editor-in-chief of Healthcare IT News
Email the writer: mike.miliard@himssmedia.com
Healthcare IT News is a HIMSS publication.