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This article was written by Jessica Howe and Zoe Pruitt.
A pilot study shows that a new assessment tool—designed by MedStar Health Research Institute—can identify areas for improvement in electronic health records, potentially improving usability and patient safety.
There might be more iconic medical instruments, like the stethoscope or the reflex hammer, but the electronic health record (EHR) is how modern providers manage patient care. These critical systems may make it easier for clinicians to order, manage, and review medications, lab tests, and diagnostic images while getting a complete picture of a patient’s health.
However, when EHRs are difficult to use or require complicated data entry steps, unintended consequences such as delayed care or safety risks can occur:
- A 2017 survey of over 5,000 physicians gave current EHR systems an "F" grade for usability.
- In 2018, a MedStar Health Research Institute team found that EHR usability challenges may have contributed to patient safety events in some healthcare facilities between 2013 and 2016.
- As many as 500 vendors offer EHR products customized for a medical center’s needs. That means no two EHRs are identical.
Developing a broadly helpful tool for diverse digital health systems has proven challenging. However, the benefits—including happier providers and safer patients—make solving this problem a research imperative.
So, in 2022, our team of investigators with the National Center for Human Factors in Healthcare designed and tested an assessment tool to help healthcare centers evaluate and improve EHRs to keep patients safer.
Scholars at @MedStarResearch and @medicalHFE are making healthcare safer for patients and better for providers by developing a tool to improve electronic health records. #EHR #PatientSafety #PhysicianBurnout: https://bit.ly/3Ml5GS1.Click to Tweet
Pilot study identifies opportunities for improvement.
To test this tool, we focused on problems that can occur when providers order medication in the EHR, including:
- Alerting: Alerts or other feedback are absent, incorrect, or ambiguous.
- Availability of information: Getting relevant data is hampered because it is entered or stored incorrectly or can’t be retrieved.
- Data entry: The process is impossible or too time-consuming to enter information.
- System automation and defaults: EHR presents spontaneous, unpredictable, or nontransparent information to the clinician.
- Visual display: Cluttered, confusing, or inaccurate presentation results in difficulty interpreting information.
Our pilot study engaged two healthcare systems using prominent EHR vendors. Five physicians from each healthcare system agreed to answer questions in our assessment tool in a test environment.
Using the assessment tool, we identified 15 opportunities to improve EHRs between the sites, including:
- Only a blank screen, not an error message, when a search returned no results
- No search results returned for some specific search terms
- Irrelevant, illogically ordered, or limited search results, such as only showing the generic drug name
- Inability to filter search results for relevant information
- Redundant or irrelevant information requested from the user
- Search bar failed to auto-fill or default to the expected information
With this type of user experience information in hand, systems administrators and EHR developers can work to improve their systems. Each incremental improvement will lead directly to increased patient safety and better working conditions for clinicians.
Next steps: Improving EHRs for everyone.
As we seek to broaden and refine the assessment tool, MedStar Health Research Institute and the Human Factors team aim to test the tool with various EHR systems and processes beyond ordering medications.
Our results show that any healthcare facility can self-administer this cost-effective assessment tool after further testing and evaluation.
The benefits of making electronic health records better, more usable, and safer are wide-reaching for clinicians and patients. This tool is a significant step in that direction, and we’re leaning into future iterations to help keep patients even safer.
This project was funded by grant R01 HS023701-02 from the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services and supported by prior work funded by The PEW Charitable Trusts.
We look forward to continuing our research on identifying opportunities within EHR systems to support advancements in patient safety and seeking future funding to continue optimizing and testing the tool.