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EHR Usability Problems Linked To Potential Patient Harm

Posted on April 9, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If you’re a clinician, you’ve probably always felt that EHR usability problems were a factor in some patient care glitches. Now, there’s some research backing up this hunch. While the numbers of EHR-specific events represented in the study are relatively low, its lead researcher said that it probably underestimated the problem by several orders of magnitude.

The study, which was profiled in the American Journal of Managed Care concluded, that at least some patient safety events were attributable to usability issues. The study, which was just published in JAMA, involved the analysis of nearly 2 million reported safety events taking place from 2013 to 2016 in 571 healthcare facilities in Pennsylvania. The data also included records from a large mid-Atlantic multi-hospital academic medical system.

Of the 1.735 million reports, 1,956 (0.11%) directly mentioned an EHR vendor or product. Also, 557 (0.03%) include language explicitly suggesting that usability concerns played a role in possible patient harm, AJMC reported.

Meanwhile, of the 557 events, 84% involved a situation where patients needed to be monitored to preclude harm, 14% of events potentially caused temporary harm, 1% potentially caused permanent harm and under 1% (2 cases), resulted in death.

The lead researcher on the study, Raj Ratwani, PhD, MA, told the AJMC that these issues are unlikely to resolve unless EHR vendors better understand how providers manage the rollout of their products.

Even if the vendor has done a good job with usability, he suggests, healthcare organizations adopting the platform sometimes make changes to the final configuration during their implementation of the product, something which could be undoing some of the smart usability choices and safety choices made by the vendor. “We really need to focus on the variability that’s occurring during the implementation and ensuring that vendors and providers are working together,” Ratwani said.

Along the way, it’s worth pointing out that the researchers themselves feel that the actual number of usability-related patient safety events could be far higher than the study would suggest.

Ratwani cautioned that he and his team took a “very, very conservative approach” to how they analyzed the patient safety reports. In fact, he suspects that since patient safety events are substantially underreported, the number of events related to poor usability is probably also very understated as well.

He also noted that while the study only included reports that explicitly mentioned the name of the vendor or product, clinicians usually don’t include such names when their writing up a safety report.

Docs Gone Wild

Posted on March 26, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Update: Be sure to read A Davis’ comments on this post as well where he provides some more perspective and understanding on the magnitude of the issue.

And in a bit of a break from our usual EMR and EHR content, we have a couple of stories that caught my eye on Fierce Healthcare.

The first story is about a talk on provider disruptive behavior presented at the American College of Healthcare Executives (with the somewhat hilarious acronym ACHE) Annual Congress in Chicago. The kind of behavior that includes ponytail-flipping, pestering patients and colleagues for dates and not taking no for an answer, threatening to use AK47 etc. Rolling your eyes because you’ve never encountered these doctors from hell? Me too. To a person, the doctors I’ve encountered here in the US have been professional, courteous and polite.

But how common is this kind of stuff?

The Fierce article doesn’t say, but the not-so-subtly titled “Physicians behave badly online” provides some statistics on doctor behavior online.

The litany of complaints against doctors is as long online. The most common complaint is that doctors ask patients out on dates. According to the article, 48 participating state medical boards had at least one case of online misconduct, and the accusations leveled include:

Inappropriate online communication with patients (69 percent), such as sexual misconduct

Inappropriate medical practice (69 percent), such as prescribing medication without establishing a clinical relationship with the patient

Misrepresenting medical credentials online (60 percent)

The penalties for these online faux pas included reprimands, loss of licence, community service, fines etc.

Taken in totality, doctor behavior both on and off-line has some cause for concern. The same behavior in the real world translates to disruptive behavior online. I would also argue that it’s not just the same behaviors, but also the same set of doctors who misbehave. If you meet a jerk in the real world, chances are it’s the same person that might pursue you on a dating site.

The statistics as reported on Fierce Healthcare are a little fuzzy though. OK, so 69% of the 48 states had at least one reported online misconduct case, but how many doctors were involved? What percentage of doctors displayed inappropriate behavior? Were there repeat offenders, or multiple cases against the same misbehaving doctor? I don’t know. The JAMA abstract is woefully short on any meaningful details.

Does the online world just make this worse? Do we see more of this happening and since it’s so easy to connect with patients online? Does it also make the doctor more accountable for their actions since something done online can be more easily tracked and reported?

New Patient Safety Standards Proposed For EHR Certification

Posted on July 11, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a proposal that could make Meaningful Use standards and vendor certification programs more valuable. Authors writing for the Journal of the American Medical Association have suggested that the Joint Commission’s National Patient Safety Goals for 2011 be included in EHR certification and MU criteria.

Here’s how the JAMA authors suggest linking EHR standards with the NPSG list:

* Patient identification:  EHRs can and should make patient identification more reliable, in part by including patient photos. EHRs should also require caregivers to re-enter patient initials if patients seem to have similar names, the comment suggests.

* Physician notification:  EHRs should not only ping physicians when a patient has abnormal test results, but also require doctors to respond by a given deadline, according to the article.

* Improving medication safety:  As long as they don’t warp clinical workflow and create additional risk of error, EHRs should support bar code med administration and clinical decision support, the JAMA authors say.

* Infection control:  EHRs should track patients with dangerous infections, and also offer checklists which can improve clinicians’ compliance with IC protocols, according to the proposal.

* Medication reconciliation:  One of the most obvious ways the NPSGs, Meaningful Use and EHRs can work together is to support appropriate med reconciliation, particularly by improving interoperability between med lists across organizations and varied EHRs, the writers suggest.

* Suicide risk:  Here’s an intriguing idea. The authors argue that EHRs should include a checklist to assess risk for patient self-harm, as well as notifying clinicians for patients who should be screened for depression.

As an analyst, rather than clinician, I don’t have any direct comments on the list of safety proposals. But I must say that from my perspective, this approach seems smart, practical and even better, focused.  Adding specific patient safety goals to EHR standards — rather than debating over broad safety issues — looks like a great idea.  Am I missing something here, or do you share my enthusiasm?