Commitment to Improve Electronic Health Records Prevents Patient Harm

Electronic health record (EHR) systems can help ensure top-quality patient care by automatically alerting clinicians to the possibility of an allergic reaction to a drug or a dangerous medication interaction, warnings that should reduce adverse drug events. Unfortunately, research has found that these alerts aren’t always triggered when they should be. That means some patients could get medications that can cause serious harm.

Multiple factors contribute to the likelihood that these instances will occur. In some cases, a programming decision made by an EHR developer may inadvertently cause another function in the system to work improperly. Alternatively, hospitals or doctors’ offices may request EHR customizations to address specific workflow needs, but those changes may cause unintended problems. Regardless of the reason, catching these issues before they affect patients is essential.

A study published this summer in the British journal BMJ Quality & Safety looked at procedures over an eight-year period at 1,500 hospitals and suggests that frequent testing of EHR medication-ordering systems could yield new ways to improve patient safety. In these tests, done from 2009 to 2016, clinicians used EHRs implemented in their facilities to test scenarios, including ordering different medications, and measured how frequently the systems accurately detected errors that could lead to patient harm. Researchers wanted to gauge whether the mechanisms for ordering medication within EHRs had an inadvertent effect on patient safety, and whether safety performance improved over time as hospital staff gained more experience with these systems.

Overall, the research shows that hospitals that engaged in annual testing of their systems throughout the study period saw their EHRs accurately detect medication problems an average of 70 percent of the time by 2016. In contrast, those facilities that tested their EHR systems at least once—but not every year—had an average score of only 62 percent by the same year.

Although testing alone cannot prevent all potential harm, this study highlights that the hospitals that maintained a dedicated focus on identifying and preventing health information technology-related errors were less likely to encounter problems. Hospital leaders can demonstrate their commitment to reducing errors through frequent testing and practices such as creating plans for monitoring potential safety issues, using checklists (known as SAFER Guides) to assess system functions, and training staff on EHR use.

Not all hospitals, however, have implemented frequent testing or these other best practices. The Joint Commission, the nonprofit organization that accredits health care organizations, can change this by incorporating EHR safety into its requirements. For example, it could set criteria related to the testing of EHRs for safety issues—including the frequency of such testing and assessments of facility-specific customizations that may not have been tested by vendors. It also could require documentation on the rationale for any customizations and plans to mitigate risks from more challenging EHR functions, such as medication prescribing. Providers can turn to other best practices as well.  

These approaches can have a meaningful effect on patient safety, and consistent adoption of EHR safety-focused best practices by hospitals could reduce harm nationwide. The Joint Commission can and should take steps to make that possible.

Ben Moscovitch directs The Pew Charitable Trusts’ health information technology initiative.