Is your organization getting the most out of its’ EHR (electronic health record)?
To identify the root causes of—and potential solutions to— EHR usability problems, The Pew Charitable Trusts, in collaboration with the Johns Hopkins Armstrong Institute for Patient Safety and Quality, convened 70 experts representing makers of EHR systems, hospitals, clinicians, patient safety advocates, and the federal government at a workshop.
A set of core problems that hinder EHR usability emerged, along with a number of promising solutions. The results incorporate findings from the meeting and recent publications, and outlines a comprehensive approach to address EHR usability that:
Not all makers of EHR systems perform a comprehensive usability assessment before the products are deployed in hospitals and doctors’ offices. To help detect design problems, vendors should conduct three types of usability testing with the products and the clinicians who will be using them.
Conducting formative testing throughout the design process ensures that usability is a central element of the product design and that problems are identified early, when they can best be addressed. As a new EHR system is being developed, vendors observe how clinicians and other health care staff use it and receive feedback on the system’s design and interface.
Summative testing occurs once an EHR has gone through the design process. Vendors assess usability by measuring how easily and successfully providers can perform various functions, such as ordering a medication, and by obtaining formal feedback on the product from users.
Staff often request significant changes to the EHR before it's installed and clinicians use it. These changes, however, can introduce new patient safety hazards. Post-implementation testing of the product after it is implemented can find and fix these new problems.
The Office of the National Coordinator for Health Information Technology (ONC), the federal agency that sets requirements for EHRs, mandates only summative testing. Requirements are limited to evaluation of EHR functionality—for example, simply assessing whether a clinician can successfully order a medication, not examining how likely the clinician is to order a wrong medication or dosage. As a result, EHRs can meet ONC’s summative testing requirements but still have the potential to cause problems.
The focus group recommends that all EHR vendors should meet minimum standards for formative, summative, and post-implementation testing. As a first step, providers, usability experts, ONC, and vendors should agree on what these standards should include. This comprehensive testing will ensure that all products meet basic usability needs and protect patient safety.
Currently, there's no easy way for providers and vendors to track patient safety problems or set targets for improvement after systems have been implemented. Providers could track, for example, the percentage of orders made on incorrect patients, the frequency of EHR-related medication errors, and the percentage of alerts for situations that do not warrant alerting.
The National Quality Forum has called for the development of measures to improve EHR usability and safety. Vendors, hospitals, clinicians, and patient safety advocates should prioritize developing these measures. Providers can then assess the performance of their systems and work with vendors to improve areas of weakness.
Insurance companies can determine whether providers in their network are effectively preventing avoidable EHR-related safety issues. To facilitate the process, ONC could update certification criteria to ensure EHRs can provide the information necessary to calculate the quality measure.
Attendees at the symposium highlighted the difficulties they face in sharing valuable lessons about EHR implementation. For example, after identifying that clinicians were ignoring alarms about potential medication dosing errors because these were similar to other alerts, one facility worked with its vendor to differentiate among alarm sounds.
Another health system reported that it had found ways to improve the efficiency and accuracy of matching patients with their records, improving patient safety and saving clinicians significant amounts of time.
To address these issues, participants recommended creating an organization that can facilitate the sharing of providers’ experiences and can systematically examine EHR-related issues reported by providers and vendors at the national level.
They suggested that Congress pass legislation that would:
Have you played a part in your organization’s EHR implementation process? Has clinician adoption and usage been favorable? Leave us a comment below.