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The Link Between EHR Usability and Patient Safety

A graphic of a doctor looking at various potential data points and a quote that states, "Experts estimate that up to 400,000 people are injured annually due to medical errors in hospitals"

Dr. David Classen from the University of Utah Health led a recent study that found that EHR systems deemed difficult to operate did not perform well in safety assessments. The research involved an in depth look at the EHR systems across 112 U.S. hospitals and compared the experiences of 5,689 clinicians through EHR safety evaluations and found a strong connection between EHR usability and patient safety.

EHRs that users found challenging were less effective at identifying issues such as drug interactions, patient allergies to medications, duplicate orders, excessive dosages, and other harmful medication errors.

One possible explanation for this connection lies in the absence of established standards for the usability and safety of Electronic Health Records (EHRs). Individual hospitals frequently tailor EHR functionality to align with their specific requirements, potentially compromising safety in the process.

Another challenge stems from the fact that both EHR vendors and hospitals are actively working to enhance the usability of their EHR systems, but often in separate silos. This separation is partly due to the federal agency responsible for EHR oversight, the Office of the National Coordinator (ONC) for Health IT, which has developed a certification approach that only pertains to vendors, neglecting implementers such as hospitals and users including frontline clinicians.

While the ONC has introduced usability testing standards as part of its vendor product certification program, none of these standards extend to the operational EHR software as employed within healthcare organizations. Most off-the-shelf EHR vendor software undergoes substantial customization by local organizations before it becomes operational for users and in return the usability of the software in practice frequently diverges from that of the certified version.

Furthermore, experts estimate that up to 400,000 people are injured annually due to medical errors in hospitals. EHRs were expected to address this issue, but previous research has shown that they often fail to discover harmful medical errors.

This new study adds weight to the argument that poorly designed EHRs may contribute to the problem. The study was published by JAMA on 9/11/2023 and was mentioned in the article titled, "When Electronic Health Records Are Hard To Use, Patient Safety May Be At Risk" that was published by the University of Utah Health on 9/11/2023.

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