- EHR usability may contribute to possible incidents of patient harm, according to a new JAMA study.
Keene et al. analyzed free-text patient safety reports from 2013 to 2016 retrieved from the Pennsylvania Patient Safety Authority database. The database includes patient safety reports from 571 healthcare facilities throughout the state, as well as one academic health system outside of Pennsylvania.
Reports were placed into one of four harm categories. The first category comprised events that affected the patient and potentially required monitoring to preclude harm, while the second category included safety events that potentially caused temporary harm. The third category included events that potentially caused permanent harm, and the fourth and final category comprised patient safety events that may have necessitated intervention to sustain life or resulted in death.
Researchers analyzed all reports that included mention of any of the top five EHR systems or health IT companies. Two EHR usability experts reviewed all reports to determine whether the report contained language associated with EHR usability problems.
Ultimately, 1.956 of the 1.7 million reported safety events included direct mention of a health IT company or EHR system. Furthermore, 557 patient safety events suggested EHR usability was a contributing factor that led to the incident of potential patient harm.
Four-hundred and sixty-eight of these potential patient safety events required monitoring to preclude death, while only two events may have required intervention to sustain life or resulted in death.
Researchers cited a variety of EHR usability problems as contributing to these instances of potential patient harm, including data entry, interoperability, and availability of information, among others.
“EHR usability may have been a contributing factor to some possible patient harm events,” asserted researchers in a discussion of the report.
“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 5 vendors or products were included,” researchers explained.
Researchers advised legislators refine policies related to EHR usability in the future to promote patient safety and reduce the likelihood of EHR-related patient harm. However, researchers also noted patient safety reports may not be the most accurate indicators of what factors may contribute to patient safety threats.
“Patient safety reports contain limited information making it difficult to identify causal factors and may be subject to reporter bias, inaccuracies, and a tendency to attribute blame for an event to the EHR,” clarified researchers. “Additional research is needed to determine causal relationships between EHR usability and patient harm and the frequency of occurrence.”
An October 2017 study similarly cited EHR use as a contributing factor to patient injury.
Researchers at physician-owned medical malpractice insurer The Doctor’s Company compared 66 claims made from July 2014 to December 2016 with the results of an initial study of 97 claims from 2007 to 2014. Evidence showed claims involving EHR use has increased in recent years, with the number of claims involving EHR use growing from two between 2007 and 2010 to 161 from 2011 to 2016.
In most claims, EHR use was cited as a contributing factor to patient harm rather than the primary cause of a safety-related event.
Problems with EHR system design, EHR-integrated alarms, copy-and-paste errors, and other EHR-related errors were listed as potential contributing factors to patient safety issues. Researchers reasoned that the lack of health IT standardization and EHR usability testing before HITECH may be at fault for current problems with EHR design.