Issues in EHR usability contribute to patient harm

Issues with usability of electronic health record (EHR) and a lack of proper clinical processes have been linked to patient harm, according to a study published on March 27 in JAMA.


In the study, researchers from the National Center for Human Factors in Healthcare analyzed reports of possible patient harm caused by EHR.

The study included 571 reported safety events between 2013 and 2016 collected from the Pennsylvania Patient Safety Authority database. Harm categories included reached the patient and needed additional monitoring to prevent harm, potentially caused temporary harm, potentially caused permanent harm and could have resulted in death.

Overall, 1.735 million reported safety events were analyzed—1,956 specifically mentioned EHRs and were reported as possible patient harm while 557 suggested EHR usability led to possible patient harm.

Harm level analysis found 84 percent of the 557 reports reached the patient and needed additional monitoring to prevent harm, 14 percent had potentially caused temporary harm, 1 percent potentially caused permanent harm and less than 1 percent could have resulted in death.

Main challenges to EHR usability included data entry (27 percent), alerting (22 percent), interoperability (18 percent), visual display (9 percent), availability of information (9 percent), system automation and defaults (8 percent) and workflow support (7 percent).

Challenges in EHR clinical processes were identified as usability challenges happening during order placement (38 percent), medication administration (37 percent), review of results (16 percent) and documentation (9 percent).

“EHR usability may have been a contributing factor to some possible patient harm events,” wrote first author Jessica Howe, MA, and colleagues. “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.

“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. Additional research is needed to determine causal relationships between EHR usability and patient harm and the frequency of occurrence. Although federal policies promote EHR usability and safety, additional research may support policy refinement.”