WASHINGTON, DC — Marking the 10^th anniversary of the landmark federal act that encouraged hospitals, clinics, and physician offices to adopt electronic health record systems (EHRs), MedStar Health experts in patient safety and health information technology are collaborating with the American Medical Association (AMA) to push for changes to address the known risks to patient safety and clinician burnout that stem from poor EHR usability.

In their latest joint effort, MedStar and the AMA are making available for the first time videos from the clinician’s point of view that demonstrate the risks and challenges caused by poor EHR usability, which is the extent to which the technology can be used efficiently, effectively, and satisfactorily. The videos have just been made available on a new website, EHRSeeWhatWeMean.org, that presents compelling evidence for the need to act. The site specifically calls out what multiple stakeholders—policymakers, healthcare providers, EHR vendors and patients—can do. The theme of the website and campaign is ‘Everybody Has Responsibilities’ to stress the need for increased collaboration.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in February 2009 to encourage the adoption and meaningful use of EHRs to ultimately improve the safety, quality, and efficiency of patient care. As a result of this legislation and the $40 billion investment supporting it, EHRs are now used by the vast majority of hospitals, clinics, and physician offices in the United States. 

As part of the push for EHR usability and safety on the HITECH Act anniversary, MedStar is gathering signatures on a letter to the elected leaders of the United States Senate and House committees encouraging them to prioritize EHR usability and safety in their oversight of new policies being put in place by the Department of Health and Human Services. Central to this effort is a program that would allow for the open reporting of usability and safety challenges by both providers and patients so that common themes can be identified and addressed more rapidly.

MedStar built the video website based on research they conducted recently on the usability of Cerner and Epic products, which comprise more than 50 percent of the market. The research findings, “A usability and safety analysis of electronic health records: a multi-center study,” were published July 2, 2018, in the Journal of the American Medical Informatics Association.  

For the study, 12 to 15 emergency physicians from four health systems (two using Cerner and two using Epic) were given common tasks mimicking real patient cases—placing orders for medical imaging, lab tests and medications. Researchers collected data pertaining to the variability of performance at each site.

“The results of this study reinforce the assessment that ensuring the usability and safety of EHRs is a joint responsibility between physicians, technology vendors and technology purchasers that requires collaboration with these stakeholders at each stage of design, development and implementation,” said AMA CMIO Michael Hodgkins, M.D. “The health care system must have confidence in the EHR systems used to manage patient care.”

Dr. Ratwani and MedStar Health have worked extensively with the AMA, Pew Charitable Trusts and other collaborators on EHR safety and usability over the past several years. Major journal articles include:

• Examining EHR usability and patient safety
            Ratwani, R.M., Savage, E., Will, A., Fong, A., Karavite, D., Muthu, N., Rivera, A.J., Gibson, C., Asmonga, D., Moscovitch, B. and Grundmeier, R., 2018. Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings. Health Affairs, 37(11), pp.1752-1759.

            Howe, J. L., Adams, K. T., Hettinger, A. Z., & Ratwani, R. M. (2018). Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. Journal of the American Medical Association (JAMA), 319(12): 1276-1278.

• Examining EHR vendor usability processes.

            Ratwani, R.M., Fairbanks, R.J., Hettinger, A.Z. & Benda, N. (2015). Electronic Health Record Usability: Analysis of the User Centered Design Processes of Eleven Electronic Health Record Vendors. Journal of the American Medical Informatics Association.

• Examining EHR vendor adherence to usability and safety policies.

            Ratwani, R.M., Benda, N., Hettinger, A.Z., & Fairbanks, R.J. (2015) Electronic Health Record Vendor Adherence to Usability Certification Requirements and Testing Standards. Journal of the American Medical Association (JAMA) 314(10):1070-1071.

• Comparing policies on EHR usability and safety to other industries.
            Savage, E., Fairbanks, R.J., & Ratwani, R.M. (2017). Are informed policies in place to promote safe and usable EHRs? A cross industry comparison. Journal of the American Medical Informatics Association. 

• Demonstrating the impact of EHRs on clinician performance.

            Benda, N., Meadors, M., Hettinger, A.Z & Ratwani, R.M. (2015). Emergency Physician Task Switching Increases with the Introduction of a Commercial Electronic Health Record. Annals of Emergency Medicine.

• A framework for comparing the usability of EHRs and challenges with comparing usability.

            Ratwani, R.M., Hettinger, A.Z., Kosydar, A., Fairbanks, R.J. & Hodgkins, M. (2016). A Framework for Evaluating Electronic Health Record Vendor User Centered Design and Usability Testing Processes. Journal of the American Medical Informatics Association. Ocw 092.

            Ratwani, R.M., Hettinger, A.Z., Fairbanks, R.J. (2016). Barriers to Comparing the Usability of Electronic Health Records. Journal of the American Medical Informatics Association.

• Implications of EHR downtime on patient safety.

            Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: an analysis of patient safety event reports. Journal of the American Medical Informatics Association. 25 (2), 187-191.

About the MedStar Health National Center for Human Factors in Healthcare

The MedStar Health 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, clinicians, and other experts to create a safer and more efficient healthcare environment through four core services in research, usability, safety advisement, and education. The center is part of the MedStar Institute for Innovation and is also affiliated with the MedStar Health Research Institute and MedStar Institute for Quality and Safety. 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.    

Ann C. Nickels
[email protected]
410-772-6661