Report Shows How EHR Usability Issues Jeopardize Pediatric Patients

While hard-to-use electronic health records can cause headaches for physicians and nurses, a report from the Pew Charitable Trusts makes clear that EHR usability issues can lead to serious health consequences for patients, particularly when it comes to prescription medications.

As part of its ongoing research into EHR usability, Pew last month published a paper highlighting a dozen cases where EHR usability challenges led to drug-related errors involving pediatric patients. The cases were chosen because they were emblematic of the problems Pew found when it worked with two children’s hospitals and one health system to investigate EHR-linked incidents.

Ben Moscovitch, M.A., Pew’s project director for health information technology, said part of the issue was the rapid transition to EHRs that came with the passage in 2009 of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Through that process, electronic records didn’t address some of the inherent safety issues with paper charts and introduced some new challenges that didn’t previously exist,” he told Inside Digital Health™.

Moscovitch said the Office of the National Coordinator for Health Information Technology (ONC) doesn’t require testing after an EHR system has been customized for a particular health system. That also leads to significant problems.

“EHR functions may work without safety issues in some facilities, while the unique workflow or customizations in others may contribute to a problem,” he said. “Better testing of these EHRs before and after their implementation can help identify safety concerns so that EHR developers, healthcare facilities and others can develop solutions to reduce patient harm.”

The 21st Century Cures Act, passed in 2016, gives ONC the opportunity to address the issue by requiring that safety become a reportable component in the required EHR Reporting Program. ONC has yet to finalize those regulations.

In the meantime, hospitals and patients are battling the consequences of preventable errors.

For instance, one hospital report described how a physician left a note in an EHR text box indicating that a patient shouldn’t receive a particular medication if their blood pressure fell below a certain mark. But that text box wasn’t designed to be displayed when the nurse used the EHR system. As a result, the nurse administered the drug when the patient’s blood pressure was too low.

In another case, a default setting created a potentially dangerous situation when a physician prescribed an antiviral drug for a transplant patient and did not realize that the duration setting provided a 30-day prescription without refills. In reality, the patient was supposed to keep taking the medication indefinitely in order to curb the risk of infection or rejection. The doctor didn’t notice the error until the patient had been off the medication for five days.

Moscovitch said EHR technology can be a tool to provide better care for patients. But the key to fixing and preventing such errors is raising awareness and promoting better testing and safety benchmarks.

“ONC can significantly improve awareness and understanding of usability-related safety risks through the EHR Reporting Program, where data will be collected and publicly released,” he said. “In addition, the Joint Commission, which accredits hospitals, can embed health IT-related safety elements in its accreditation program.”

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