5 Recommendations to Make EHRs Safer for Pediatric Patients

MedStar Health and Pew Charitable Trusts Respond to Congressional Act

September 10, 2018

Washington, D.C. (September 10, 2018)—Experts with MedStar Health’s National Center for Human Factors in Healthcare have leveraged their past research into the safety and usability of electronic health records (EHRs) to join with The Pew Charitable Trusts in offering recommendations to the federal government for making the health IT systems safer for children, whose unique needs make them particularly vulnerable to documented EHR usability and patient safety issues. The recommendations were published today by the American Medical Association in its journal  JAMA Pediatrics, in a Viewpoint article entitled “Improving Pediatric Electronic Health Record Usability and Safety through Certification.”

The authors are Raj M. Ratwani, PhD, with National Center for Human Factors in Healthcare,  and Ben Moscovitch, MA, and Josh P. Rising, MD, with The Pew Charitable Trusts.

Their recommendations are in response to a provision in the 21st Century Cures Act, passed by Congress in 2016, for the Office of the National Coordinator to develop a voluntary program that would certify EHRs in a way that accounts for unique issues in pediatric care.

“Children have unique healthcare needs, and oftentimes care processes that may work well for adults do not work for children,” says Dr. Ratwani.  “While we  have recognized the unique needs of children when it comes to things like medications, we have not recognized this need when it comes to technology like the electronic health record.”  EHRs, which are almost universally used across the United States to manage patient care, are not tailored to the unique needs of children or clinicians who treat them, and this can put pediatric patients at risk.

The authors cite a couple of instances where the poor usability of EHRs has contributed to potential harm:

  • Medication dosages for children are based on weight, and poor EHR usability has contributed to overdoses being given when a confusing EHR display makes it difficult to enter a child’s correct weight.
  • Age-appropriate vaccinations may be overlooked due to the EHR’s failure to notify the clinician of a needed vaccine or the wrong vaccination may be given when the EHR recommends a vaccine that is inappropriate given the child’s age.

The authors provide these five recommendations for a certification program:

  • Require EHR vendors to provide evidence that they are employing a user-centered design process.
  • Require that usability test participants represent the clinical end users.
  • Define and require the use of rigorous test cases to assess usability and safety.
  • Recognize that EHR implementation is crucial to safety, and consider the entire EHR life-cycle—not just the development phase—when granting certification.
  • Encourage transparency in sharing usability and safety challenges to improve safety and EHR product.

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About the National Center for Human Factors in Healthcare

The National Center for Human Factors in Healthcare occupies a unique position in the United States as the largest human factors program embedded within a healthcare system. It brings together human factors scientists, systems safety engineers, health services researchers, and clinicians to conduct safety science and applied research in medicine to improve safety, quality, efficiency, and reliability. The center is part of the MedStar Institute for Innovation and is affiliated also with the MedStar Health Research Institute. MedStar Health, the parent organization, is the largest not-for-profit healthcare provider in the Maryland and Washington, D.C., region, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.  

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