- Gathering input from all types of healthcare stakeholders is critical to addressing potential issues with EHR use, which will in turn help to improve patient care and reduce provider burden, according to Pew Charitable Trusts.
Alert fatigue, over customized EHRs, auto-refresh mix-ups, unclear default settings, and incomplete lab results are all possible EHR usability issues that can cause patient harm, data from Pew illustrated.
“Varied EHR formats and a lack of consistent, intuitive interfaces – combined with EHR customization by health care facilities and lack of post-implementation testing and insufficient clinician training – can lead to errors, some of which may cause serious injuries or even death,” Pew wrote.
Establishing a health IT safety collaborative is one way that healthcare providers can improve EHR use. Stakeholders can be brought together with a collaborative and share data on patient safety incidents “in a nonpunitive environment.” From there, stakeholders can “develop solutions for common and significant usability issues.”
Pew also suggested that entities conduct safety tests throughout the entire EHR lifecycle. Basic functionality and usability of functions should be regularly tested during development and after implementation. Developers, doctors, nurses, pharmacists, and all other professionals who regularly use the EHR system should also be involved in the testing process.
With alert fatigue, a lifesaving warning could be missed, Pew cautioned. For example, EHR systems should be designed to flag potential problems (i.e., dangerous drug interactions with different medications). But if the system creates alerts too frequently, a clinician may ignore them.
There can also be a downside to EHRs being too customized, Pew explained.
“Health care facilities may work with vendors to customize certain aspects of their EHR system to fit their workflow, displaying information deemed most critical to clinicians at a particular facility,” the organization stated. “But those customizations – which may be requested by the facility or staff – may not have undergone rigorous testing and could lead to unintended safety consequences.”
Auto-refresh mix-ups occur when EHRs automatically refresh patient lists and revert to the default view. Pew noted that providers could inadvertently make medical decisions based on the wrong patient if they do not realize that the system refreshed a particular list.
Default settings can also be dangerous with medication dosages, the research pointed out.
“Clinicians may think they are ordering a fixed dose of a drug, when instead what they enter is multiplied by the patient’s weight, potentially contributing to overdoses,” Pew said.
Finally, incomplete lab results can lead to incorrect medical decisions because a provider does not have a patient’s complete information. A physician may not realize that not all lab results are being shown on her screen, or know that some lab results have been delayed or are still undergoing testing.
Pew previously stressed the importance of collaboration for improved EHR use in a December 2017 report, in which researchers also explained safety problems could be caused from an EHR system’s design or EHR customization during implementation.
“An interface that is cluttered may cause confusion or an inability to locate key information, whereas an overly bare display may force the clinician to search for information in multiple places,” the Pew report said. “Important design principles include knowing what users need for a simple interface, removing complexity, using simple and clear terminology, emphasizing key elements, and using color effectively to draw users to important areas.”
Employee training will also be critical for proper EHR use and ensuring patient safety, researchers explained. Classroom and web-based sessions, self-paced courses, customized programs, and simulation training can all help doctors, nurses, and other care providers.
The Office of the National Coordinator also has online tools available for EHR training, the research team noted.
“Its website allows users to share experiences with EHRs, helps to solve obstacles, and is a hub for EHR implementation materials,” the researchers wrote. “The consortium also offers training and other resources on workflow redesign, EHR implementation, and even vendor selection and management.”
Optimizing EHRs for provider use is important, but organizations must also consider patient safety throughout the entire EHR lifecycle. Proper EHR use that keeps patient safety a top priority can be facilitated through national collaboration measures in the industry and with thorough testing measures.