WBB's Thought Leadership

EHR Usability Issues May Increase Patient Safety Risk

January 2

The EHR has become a standard tool of delivering medical care, but often suffers from user interface defects, lack of alignment with clinical workflow, and incomplete or ineffective user training.

Electronic Health Records (EHR) faults can result in incomplete lab results or medical order overwrites due to cluttered or uninformative user interfaces, poor alignment with clinical workflow, and user training that is not sensitive to patient safety or available in forms that suit the user needs.

WBB Take: EHR systems have become ubiquitous in healthcare due in part to government stimulus for EHR adoption, and increased awareness in the industry of potential benefits for patient management, inventory control, and billing.
However, EHR design, implementation, and adoption have lagged in terms of usability for clinical planning and delivery, patient follow-up and case management, and medication reconciliation and safety checking. Perhaps the biggest gaps between what clinicians need and what most EHRs deliver in practice are the user interface and ability to align with clinical workflow. Many EHR implementations do not place the right information in front of the clinician at the right time and in the right format, and result in wasted effort and distraction to click from tab to tab or module to module in order to complete a clinical workflow. Likewise, EHR training is often not sufficiently role-based, and often does not adequately follow typical clinical workflow scenarios.
As a result, EHR use is frustrating to many clinicians, and serves as a source of distraction and potential error when it should be supporting workflow and reducing the risk of error.
Cited by Matthew Loxton


Excerpt: “Electronic health records are quickly becoming the standard way clinicians track and retrieve patient information, but EHR usability can put patient safety in jeopardy, according to a report from the Pew Charitable Trusts. EHRs are a critical part of patient care. Clinicians need up-to-date, accurate information to make informed decisions, and EHRs allow access to this information with just a few clicks.”

“However, EHRs are not always efficient in accomplishing the goals of a health organization. Pew states that EHRs have contributed to numerous errors that may increase patient risk, including incomplete lab results or medical order overwrites. The report also noted that the nonprofit ECRI Institute listed the design and use of EHR systems as its top concern in 2016

“EHR usability affects clinicians as well. A 2015 peer60 report found that 50 percent of EHR users considered usability to be a major issue. Nearly 20 percent of respondents stated that usability was the reason they were looking for EHR replacements. These usability issues must be fixed to maximize the efficiency of EHRs, says Pew.”

“Ensuring consistency and clarity of EHR user interfaces
The user interface refers to the system’s design and layout, Pew explains. It is what clinicians see when retrieving data or entering new data into the system. ‘An interface that is cluttered may cause confusion or an inability to locate key information, whereas an overly bare design may force the clinician to search for information in multiple places,’ the report states.”
“Pew notes that user interface design should eliminate complexity, emphasize key elements, and use color to draw users to important areas.”


“Carefully customizing workflows to avoid errors
Organizations can customize their EHR systems to fit their particular needs or to display certain critical information for their clinicians. While this is a good way for an organization to ensure an EHR system works for them, Pew states that customizations “may not have undergone rigorous testing by the care team or the product developer to detect potential safety concerns.” This could lead to problems for patients down the line.”

“According to Pew, workflow ‘reflects how and when things are done within a healthcare setting.’ It includes the clinical actions performed at every level, from administrative tasks to the work of nurses and physicians.”

“Prioritizing staff training to ensure patient safety
Clinicians must receive thorough training to use EHR systems efficiently and to ensure patient safety. This is important, as evidence suggests that usability improves as clinicians gain more experience with the technology. Pew notes that EHR developers offer training in a variety of forms, including web sessions and simulation training.”

“Currently, the government has practices in place to monitor EHR safety, including product testing throughout development, government oversight and certification, and internal quality and safety leaders.”
Source: Health IT Analytics


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