The American Medical Association and health system operator MedStar Health have published a report laying out a set of proposals designed to improve EHR safety. The report, which is also backed by The Pew Charitable Trusts, looks at ways that use of EHR usability can fail to prevent or even lead to patient harm.
As readers will know, to meet certification criteria EHRs currently need to conform with EHR usability requirements established in 2015. Developers need to document how they meet clinician needs and conduct formal usability testing addressing clinicians’ efficiency, effectiveness and satisfaction in using the system.
Unfortunately, the current generation of certification standards don’t focus specifically on high-prevalence safety hazards, which may mean that the process doesn’t address how usable some important EHR features are, the report says. Plus, even the earlier versions didn’t do much in regards to usability.
Over time, of course, both EHR developers and providers have begun to take these issues more seriously, and as the paper points out, are moving beyond the minimum required to meet certification standards.
For example, developers have agreed to review safety incidents with patient safety officers and product users, along with sharing such information across healthcare facilities. Also, providers have taken their own steps in this direction, such as protecting EHR safety surveys or establishing safety teams tasked with identifying EHR-related problems. As we all know, however, there’s a lot more to be done.
To make more progress, the groups suggest, EHR developers need to design more rigorous, safety-focused test cases. While they already need to run such real-world-oriented test cases, which are required for certification, but these studies might not be looking for the right things, the report says.
To be truly useful, these test cases should represent the expected uses of the technology; should represent a clinically-oriented goal with clear measures of success and failure; test known areas of risk and efficiency; and address a defined audience.
The paper also includes a list of criteria developers and providers can use to boost EHR usability and safety across the system’s entire lifecycle. For providers, this includes establishing a culture of safety which will support EHR-based safety efforts; seeing that user needs and product capabilities are aligned; customizing and configuring the system to meet those needs; implementing and maintaining the EHR carefully; and training clinicians to use the product safely and effectively.
Not surprisingly, research on these topics is ongoing, but some providers are more engaged than others. I was interested to see that MedStar Health’s National Center for Human Factors in Healthcare continues to work with the AMA on these issues. For example, about two years ago the partners released a joint framework designed to rank EHR usability. (The partners also use the framework to rank the usability of several widely-implemented systems, including that Allscripts and McKesson were doing the best job at the time. That was fun.)
I hope to see more work on the links between EHR usability and safety in the future, as well, of course, as feedback on how to address both. We simply don’t spend enough time on this subject.