Pew: 'Poor' EHR usability can provoke drug, treatment errors for pediatric patients

Challenges to EHR usability can pose medication safety risks, such as incorrect prescriptions, overdoses and treatment delays, which can leave pediatric patients particularly vulnerable, according to a report from the Pew Charitable Trusts.

Pediatric patients are susceptible to errors in EHR usability because their dosages are often adjusted by weight and age. In November, Pew published research in Health Affairs that identified incidents in EHRs that added to drug prescribing and administration errors, which put pediatric patients' safety at risk, according to the report. Pew worked with two children's hospitals and one large mid-Atlantic-based health system on the study.

Through the research, Pew identified four main categories of EHR usability challenges:  information display, difficult data entry, system feedback and workflow support. The following cases highlight some of the EHR usability-related medication safety events cited in the study:

Information display: Nurses administered a drug that left the patient at risk of low blood pressure because orders to not administer it were inaccessible.

Difficult data entry: An automated EHR function incorrectly generated a vaccination schedule for a 4-month-old infant after the system's default settings automatically checked a box that indicated the patient was older than six months. Clinicians identified the mistake and did not administer the inappropriate vaccines, but the EHR would not let them modify the vaccination plan or uncheck the box that showed the wrong age.

System feedback: A provider who intended to prescribe indefinite antiviral therapy for a transplant patient accidentally selected the EHR's preset 30-day, "no refills," order, which caused five-day treatment lapse for the patient that increased risk of infection and transplant rejection.

Workflow support: Emergency care for an infant patient was delayed because the EHR required her weight and Apgar score, a composite measure of health indicators, to be entered before clinicians could start a new record for her. The patient needed an emergency blood transfusion before the Apgar score could be obtained. Physicians eventually placed the transfusion order through the patient's twin brother's record.

Authors of the Pew report concluded that ONC should include safety-related requirements, such as encouraging safety testing of EHR systems by pediatricians, to reduce the possibility of EHR usability errors. In January, the nonprofit research and policy organization sent a letter to ONC urging the agency to prioritize EHR usability safety, specifically among pediatric patients, to reduce patient harm.

To access the full report, click here.

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