Clinician Involvement Critical in EHR Design, Improvement

Larry Hand

June 29, 2013

To ensure patient safety and quality of care, front-line clinician involvement is critical in the design and deployment of electronic health record (EHR) systems, as reported in an article published online June 24 in the Annals of Emergency Medicine.

Efforts to improve EHR systems are constantly evolving, add study authors led by Heather L. Farley, MD, from the Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.

The researchers represent a joint committee composed of members of the Quality Improvement and Patient Safety Section and the informatics section of the American College of Emergency Physicians, who combined efforts to analyze the benefits and potential threats to patient safety that can result from EHR choices.

Some vendors prohibit users from sharing hazards even in the academic literature.

Although EHR systems that are marketed and sold to hospitals and healthcare providers are certified by the Certification Commission for Health Information Technology, that process is not focused on safety issues, the authors write, and no mechanism exists to allow or encourage system users to address ongoing safety issues or provide feedback. "In fact, some vendors prohibit users from sharing hazards even in the academic literature," they write.

Emergency Department (ED) characteristics, including rapid turnover, frequent transitions of care, continual interruptions, large patient volume, and unfamiliar patients, make EDs "particularly error prone" when using EHR systems or ED information systems (EDISs) to reduce medical errors and standardize care, the authors write.

The report describes 4 potential "fictitious yet realistic clinical scenarios" in which choice of EDIS can make a difference and offers 7 recommendations to improve patient safety when using EDIS. The 4 pitfalls revolve around communication failure, poor data display, wrong order/wrong patient errors, and alert fatigue.

The recommendations are:

  1. A local ED clinician should champion an EDIS improvement process and local improvement group and serve as liaison among clinicians, technical staff, and hospital leadership.

  2. A multidisciplinary EDIS performance improvement group should regularly meet and discuss improvements with ED and hospital leadership.

  3. A process should exist and be used for reporting and addressing safety issues, and prospective risk assessments should be conducted.

  4. A process for addressing EDIS patient safety concerns should be timely, as well as transparent, among ED providers, hospital leadership, and EDIS vendors

  5. Lessons learned should be shared publicly, including with other EDs using the same EDIS.

  6. EDIS vendors should heed local safety improvements and distribute necessary changes to all installation sites in a timely fashion.

  7. EDIS vendors should be accountable for system design and remove "hold harmless" or "learned intermediary" clauses in software contracts.

Limitations of the report include a lack of evaluation by experts in human factors engineering and the need for input from a broad array of other stakeholders including patients, the authors write.

In addition to the 7 recommendations offered, the group of experts also endorses the Institute of Medicine recommendations from a 2011 report entitled "Health IT and Patient Safety: Building Safer Systems for Better Care," covered by Medscape Medical News at the time of publication.

The authors conclude, "Together, these documents provide a framework that should be studied by every ED to ensure patient safety with regard to EDISs."

The authors have disclosed no relevant financial relationships.

Ann Emerg Med. Published online June 24, 2013. Abstract


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