New Research Reinforces Importance of Reporting and Collaboration to Prevent Patient Harm in Electronic Health Record Systems

New Research Reinforces Importance of Reporting and Collaboration to Prevent Patient Harm in Electronic Health Record Systems

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Washington, D.C., — A growing body of evidence indicates the need for additional evaluation of and improvements to electronic health record systems (EHRs), which have been adopted by the majority of U.S. health providers in the past decade to advance health and comply with federal policy. The latest study, presented via a research letter published in the Dec. 17 issue of the Journal of the American Medical Association (JAMA), reinforces that there is a real possibility for EHR platforms to cause patient harm — making it increasingly important for stakeholders to collaborate to improve this critical health information technology.

In a first-of-its-kind examination of EHR surveillance data collected by The Office of the National Coordinator for Health Information Technology (ONC), the MedStar Health National Center for Human Factors in Healthcare research team examined more than 350 reports of EHR issues perceived to violate the federal certification program, as defined by the U.S. Department of Health and Human Services. These reported issues may be related to the design, functionality, or security of the product, as well as required disclosures about the product.

These findings begin to estimate the reach of EHR product issues on patient safety, with 39.5% of surveilled product identifications having an issue with a potential for patient harm. The researchers further estimate that 786 hospitals and 37,365 individual providers may have used the products with these potential patient safety issues based on required product use reporting.

“Technology and innovation are needed to advance the care delivered to patients; however, while innovations in medications and medical devices are guided by strict surveillance programs in the U.S., no such rigor exists to evaluate the safety of the electronic health record systems that U.S. providers constantly rely upon,” said Raj Ratwani, PhD, director of MedStar Health Human Factors Center. “Our latest research reinforces not only the potential for patient harm across the U.S., but also the limitations in surveillance and challenges in reporting and widely addressing incidents. We encourage all stakeholders to work together on new, transparent, and proactive processes for monitoring, reporting, and addressing safety issues.”

In addition to the novel review of EHR surveillance data, the MedStar Health Human Factors Center also recently completed an additional evaluation of data pertaining to the usability satisfaction of leading EHR systems. Published in JAMA Network Open on Dec. 13, 2019, an analysis of the System Usability Scale (SUS) data for 27 of 70 widely-used EHR vendor platforms found that there was no statistical improvement in EHR satisfaction SUS scores between 2014 and 2015 certified products. In fact, despite past research finding that poor EHR usability relates to both clinician burnout and patient harm, SUS scores decreased for 44% of vendors from 2014 to 2015.

Dr. Ratwani and MedStar Health have worked extensively with the AMA, Pew Charitable Trusts, and other collaborators to advance EHR safety and usability over the past several years. Visit for more information and details on ways key stakeholders — including EHR vendors, policymakers, healthcare providers, and patients — can address these issues.   

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.