Most healthcare providers, patients, and industry stakeholders agree EHR technology has the potential to yield marked improvements in population health management, predictive medicine, and clinical decision-making. However, EHR use also introduces new risks to patient safety. A study released in October of 2017 found EHR use has been listed as a contributing factor to patient injury at an increased rate over the past decade. Poorly-designed EHR systems combined with human error have resulted in patient safety problems in an increasing number of malpractice claims from 2007-2016. Here are a few steps providers and IT developers can take to deter this rising trend.
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Limit use of copy-paste functionality
Shortcuts built into EHR systems have been embraced by provideders as a way to reduce the amount of time spent at their monitors. However, one shortcut could potentially pose a threat to patient safety.
Researchers in a 2017 JAMA study found providers may be increasing the risk of patient harm by entering repetitive or inaccurate EHR clinical data into physician notes using copy-paste functionalities.
Ultimately, researchers found resident physicians used copy-paste to enter more than half of all data into physician EHR notes. The prevalence of copied information in physician notes increases the likelihood of repetitive, nonspecific, and irrelevant data existing in EHRs.
“Copying or importing text increases the risk of including outdated, inaccurate, or unnecessary information, which can undermine the utility of notes and lead to a clinical error,” researchers stated.
Researchers recommended healthcare organizations and health IT developers consider ways to limit the amount of copied information in physician EHR notes by inhibiting certain information from being saved.
“This finding could spur EHR design that makes copied and imported information readily visible to clinicians as they are writing a note but, ultimately, does not store that information in the note,” researchers stated.
The National Institute of Standards and Technology (NIST) also cautioned providers against relying too heavily on the copy-paste functionality for clinical documentation.
Along with the ECRI Institute and U.S Army Medical Research and Material Command’s (MRMC) Telemedicine and Advanced Technology Research Center (TATRC), NIST offered recommendations for reducing copy-paste-related errors.
Specifically, researchers recommended implementing EHR designs that enhance the visibility of information being selected for copy and paste to prevent users from inadvertently copying certain unrelated or unwanted areas of information.
Additionally, authors recommended locking certain areas or sources of information to prevent copying altogether. For example, organizations could disable the copy-paste function when providers are entering data into a blood bank information system to prevent errors related to blood transfusions.
Limiting or restricting over-use of the copy-paste functionality during clinical documentation can help to reduce patient safety threats stemming from irrelevant or redundant information.
IMPLEMENT A SIMPLE, UNCLUTTERED EHR INTERFACE
Simple EHR interfaces are best, according to a recent report from Pew Charitable Trusts.
Convoluted or overly-complex EHR designs can confuse providers and negatively impact clinical productivity. Poorly-designed EHR interfaces can also inhibit providers’ ability to quickly find information.
Furthermore, EHR interfaces that lack key information altogether can cause clinicians to search for data in multiple places, which may slow down patient care delivery.
“Important design principles include knowing what users need for a simple interface, removing complexity, using simple and clear terminology, emphasizing key elements, and using color effectively to draw users to important areas,” advised the authors.
By extension, healthcare organizations should also refrain from excessive EHR customization.
“These customizations — which may be requested by a health care facility or staff — may not have undergone rigorous testing by the care team or the product developer to detect potential safety concerns,” the research team wrote.
Keeping EHR design simple improves EHR usability and enables providers to view information in as clear, concise, and straightforward a manner as possible. Ensuring EHR data is clear and accessible can help to reduce the chances of clinical errors and EHR-related safety risks.
IMPROVE PHYSICIAN EDUCATION SURROUNDING EHR USE
EHR system design can play a hand in heightening the risk of patient safety problems, but human error is more commonly the culprit.
Reducing safety risks related to human error require improved physician education about EHR technology and use. At the 2017 ONC Annual Meeting, a panel led by ONC Chief Medical Officer (CMO) Andy Gettinger discussed the importance of understanding how EHR software works.
In an effort to increase provider understanding of EHR technology, ONC is working to develop a “Usability Change Package” focused on building a tool provider organizations can use to gain a base level of knowledge about usability.
The resource will provide informational materials to EHR users in a variety of settings to help them assess and improve the usability of their systems.
“Now with ONC and this change package work, we’re seeing much more attention around implementation and what is happening there,” stated Raj Ratwani, National Center for Human Factors in Healthcare Senior Research Scientist and Scientific Director.
Educating providers about the affect implementation decisions can have on the overall usability of their EHR systems can help to avoid costly, long-term software problems.
ENCOURAGE HEALTH IT DEVELOPERS TO IMPROVE HEALTH IT STANDARDIZATION
While healthcare organizations bear responsibility for EHR use-related errors, health IT developers and certification bodies can also help to reduce liability risks.
“We became aware of the potential liability risks related to the use of EHRs shortly after their introduction, and we anticipated that EHRs would become a contributing factor to medical professional liability claims,” wrote authors in a 2017 report from the Doctors Company.
Researchers suggested most EHR-related problems could be attributed to a lack of widespread standardization among health IT developers early on after EHR adoption became common.
“Many EHR-related problems could have been avoided if the federal government had developed vendor standards for EHR use and interoperability and required beta testing in the healthcare environment to ensure usability and safety before the HITECH Act mandated its widespread adoption in 2009,”they wrote.
Improving standardization and usability testing could help to reduce or avoid EHR-related patient safety risks. Additionally, researchers suggested health IT developers take provider concerns and other feedback into account when designing EHR technology in the future.
“Physicians and other healthcare workers played a minimal role in the initial design of the EHR, and their concerns have been largely ignored,” stated researchers.
Improved communication between health IT developers and providers could serve as a way to reduce provider frustrations with EHR use and limit patient safety risks through more streamlined, standardized system design.
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