Hard-to-use EHRs may result in patient harm
EHR systems rated as being difficult to operate did not perform well in safety tests, which suggests the need to optimize EHRs for ease of use.
Photo: Al David Sacks/Getty Images
Electronic health records that are difficult to use are also less likely to catch medical errors that could harm patients, according to new research published in JAMA Network Open.
As clinicians navigate EHR systems, alerts, reminders and clinical guidelines pop up to steer decision-making. Yet a common complaint is that these notifications are distracting rather than helpful. These frustrations could signal that built-in safety mechanisms similarly suffer from suboptimal design, the findings suggest.
Researchers found that EHR systems rated as being difficult to operate did not perform well in safety tests.
Dr. David Classen, the study's corresponding author and a professor of internal medicine at University of Utah Health, said that poor usability of EHRs is the number one complaint of doctors, nurses, pharmacists and most healthcare professionals.
Authors likened the situation to the software problems that led to two deadly Boeing 737 MAX airplane crashes in 2018 and 2019. In both cases, pilots struggling to use the system foretold deeper safety issues.
"Our findings suggest that we need to improve EHR systems to make them both easier to use and safer," they wrote.
WHAT'S THE IMPACT?
Experts cited in the research estimate that as many as 400,000 people are injured each year from medical errors that occur in hospitals. Many medical professionals predict that widespread use of EHRs could mitigate the problem.
Prior research from Classen and others in 2020 showed that EHRs failed to reliably detect medical errors that could harm patients, including dangerous drug interactions. Additional reports have indicated that poorly designed EHRs could be a contributing factor.
To investigate further, the research team studied EHR systems in 112 U.S. hospitals. They compared results from an EHR experience survey taken by 5,689 clinicians with outcomes from an EHR safety evaluation tool. The Leapfrog CPOE EHR safety test examines whether medication orders that could potentially harm a patient properly triggers alert systems.
The study found that user experience strongly correlated with EHR safety. When users rated EHRs poorly, they said the systems were difficult to operate, hard to learn, slow or inefficient.
In cases where clinicians experienced those troubles, those EHR systems were less likely to flag drug-drug interactions, a patient's allergies to drugs, duplicate orders, excessive dosing or other harmful medication errors.
One explanation behind the link is a lack of quality control, Classen explained. Individual hospitals modify EHR operability to meet their specific needs, and some of these changes may be at the expense of safety. What's more, despite the fact that there are many EHR systems, there are currently no standards for usability and safety.
"Hospitals and health systems have spent more than $100 billion on EHRs over the last decade, and most believe that these systems are completely safe and usable but that is not necessarily the case," he said. "Hospitals should annually perform a safety check on their system to assure it is safe."
Improving EHR systems in the long term may need a different approach, authors said. Just as the Federal Aviation Administration, airline manufacturers and airlines jointly monitor and improve airline software, a similar collaborative effort with EHR vendors, hospitals and clinicians may be what's needed to optimize EHR software for user satisfaction, safety performance and to ultimately reduce medical errors.
THE LARGER TREND
A previous study from May found that, while EHRs facilitate straightforward, task-related communication, they limit "rich and social" communication. In other words, EHRs have a negative effect on team function and team wellbeing, the results showed.
Several physicians were interviewed for the paper. While they agreed that the EHR has improved lean and task-related communication – good for simple, uncomplicated tasks – they perceived that the EHR negatively impacts team function by amplifying disagreement and introducing conflict.
The results suggest that the EHR supports looser forms of interprofessional work, such as networking and coordination, at the expense of more intense collaboration and teamwork.
Those findings track with a 2021 study showing EHR-integrated patient-generated health data may create burdens for clinicians, leading to burnout. In particular, researchers from Northwestern University found that technostress, time pressure and workflow-related issues need to be addressed to accelerate the integration of patient-generated health data into clinical care.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
