JAMA analysis supports EHR use safety
- Concerns that EHRs may contribute to patient harm are real but, according to one research letter published in JAMA on Tuesday, the actual number of incidents appears to be extremely low.
- Of 1.7 million safety reports, just 1,956 (0.11%) named an EHR vendor or product and potential patient harm and 557 (0.03%) specifically suggested EHR usability factored into the problem.
- The analysis includes reports from 2013 through 2016 on 571 Pennsylvania-based healthcare facilities and a large academic healthcare system outside the state. Only reports that mentioned one of the top five EHR vendors or products and noted possible harm were included.
In cases that suggested possible harm, 84% required additional monitoring, 14% potentially caused temporary harm, 1% caused permanent harm and less than 1% necessitated life-saving interventions, the research letter said.
In terms of usability, the biggest challenges were data entry (27%), alerting (22%) and interoperability (18%). Visual display, availability of information, system automation and defaults and workflow support were also mentioned, but to a lesser degree — under 10%.
The authors from the University of Oxford and others in the U.K. also looked at when usability challenges were most likely to occur. The largest share of safety reports involved order placement (38%), followed by medication administration (37%), review of results (16%) and documentation (9%).
The findings add to evidence-based literature on the general safety of EHR use.
A study last year by The Doctors Company found an uptick in the number of malpractice claims in which EHRs played a role. While still very small, EHRs figured in 66 malpractice claims between June 2014 and December 2016, compared with two between 2007 and 2010. That study also pointed to issues with design, interoperability and absence or failure of alerts and alarms.
The low percentage in the JAMA study suggests administrative burdens and data entry issues are bigger challenges with EHRs. Still, more research is needed to establish associations between EHR usability and patient harm and how often they occur, the authors say.
“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 five vendors or products were included,” they wrote.