The shift from paper medical records to electronic health records (EHRs) has caused unintended patient safety problems. Although the federal government has spent more than $30 billion to encourage hospitals and medical clinics to adopt these records, design deficiencies can disrupt clinician workflow and cause providers to miss key information. This, in turn, can threaten the safety of patients. Examples include people receiving the wrong medications, clinicians accidentally dismissing alerts of harmful drug interactions, and physicians missing important test results.
To address these design-related hazards, practices for testing EHRs should focus more on safety, and the federal government, hospitals, clinicians, and software vendors should collaborate to study problems associated with these products and disseminate lessons learned.
EHR usability refers to how clinicians input information and otherwise interact with the system. Usability problems have caused serious patient safety incidents, including death:
Addressing these safety problems requires changes to the testing requirements for EHRs and more data on the most prevalent ways that the design of these records can put patients at risk.
Regulations governing electronic health records require vendors to state that their products can perform certain functions but not that those tasks can be accomplished safely. Although regulations require clinician input during the design of health record systems, researchers have found that some vendors do not appropriately consult with usability experts while their products are being developed.3
To address usability, EHR vendors should test their products for safety and functionality throughout product development (during the design process, immediately before it is sold, and following its installation within a facility).
To efficiently identify safety problems and disseminate best practices to address them, an entity should be established to convene EHR vendors, users, researchers, and the government to improve patient safety.
An expert panel convened by the Institute of Medicine first recommended the development of a safety center in 2011.4 Subsequently, experts convened by the Office of the National Coordinator for Health Information Technology (ONC), which oversees EHRs, have refined this proposal to establish a multistakeholder collaborative.5 Congress should pass legislation authorizing seed funding and encouraging the creation of such a network. Once established, this organization should develop and refine its business plan to ensure that its operations are self-sustaining.