Finding the causes of EHR failure

Despite the many promises to the otherwise, electronic health records (EHR) haven’t simplified physicians’ lives. Instead, the average physician today spends twice as much time working with EHRs than interacting with patients.

One study by the Office of the National Coordinator for Health Information Technology (ONC) found that 14% of physicians have experienced a potential medication error due to their EHR in the past month. Another 14% said that the excessive amount of alerts had caused them to overlook something important.

To solve this problem, the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Pew Charitable Trusts held a summit with 70 EHR systems experts from across the medical field. The group discussed the best possible solutions of preventing EHR medical errors, improve care quality, and improve workflow. The group published a fact sheet on their findings this month, outlining three major problems and their solutions.

“By raising the bar on testing for usability, measuring performance, and opening up ways to share learning on problems and solutions stakeholders can make progress on EHR usability and safety and help clinicians deliver safe, patient-centered, high-quality care,” they write.

Problem: Inadequate testing requirements
Sometimes EHR vendors fail to conduct rigorous enough testing on their products before they are released. Whereas a small bug, glitch, or unexpected change would be a minor annoyance in other fields, improper testing of systems can result in patient harm.
Solution: Create minimum requirements for EHR testing
Currently, only summative testing (which is done after the EHR’s design process) is mandated by the ONC. The summit agreed that additional requirements be made for both formative testing (while the system is being developed) and post-implantation testing (after it’s been installed.)

Problem: insufficient measures of HER safety and usability
The group pointed to a lack of a universally accepted metrics of EHR performance as a major issue. Without them, there’s no way to set quality benchmarks or see if an issue is specific to one system or popping up everywhere.
Solution: Create and disseminate recommendations to the healthcare field
The National Quality Forum has come up with a list of recommended measures for hospitals, vendors, and patient safety organizations to use when improving EHR safety and usability.

Problem: Poor communication of EHR failures between facilities
Between fear of infringing on EHR vendor intellectual property clauses, and a lack of clear communication system, facilities are often unable or unwilling to discuss problems they’ve had with their EHRs. This results in hospitals having to reinvent the wheel every time there’s an issue, even if the same problem was already solved in a different facility.
Solution: Create an organization to examine and manage all EHR-related issues
This step is recommended by the ONC and the Institute of Medicine. The organization would be able to share providers’ experiences without violating copyright gag orders.