Taking a systems approach to improve patient safety

It was a seminal moment in healthcare when the National Academy of Medicine (then the Institute of Medicine) released its report titled "To Err is Human: Building a Safer Health System" in 1999. The report highlighted the pervasive issues of medical error and patient harm and amplified the need for more rigor and attention to quality and safety. Unfortunately, even after 20 years of dedicated focus, medical error remains a threat to patient safety.

Usability is one factor which contributes to patient safety

Poor EHR usability contributes to medical errors and clinician burnout, which both negatively affect patient safety. Usability issues that contribute to patient harm may occur at any phase of the health IT lifecycle: design, development, implementation, customization, training and ongoing maintenance.

In the fall of 2018, the Pew Charitable Trusts, MedStar and the American Medical Association released a report titled "Ways to Improve Electronic Health Record Safety." The report recommends rigorous testing and establishing voluntary criteria across the software lifecycle to enhance the usability, safety and safe use of health IT.

More recently, industry calls for accountability for health IT — such as Medstar's recent campaign — have been growing stronger. Allscripts supports efforts to address safety concerns with a structured approach that encourages organizations to share concerns in a constructive way. One approach could be a reporting option to a neutral patient safety organization.

But efforts to improve patient safety through health IT must consider factors beyond usability. Health IT safety is a shared responsibility of all stakeholders. To achieve safety, usability and high reliability, a systems approach must address the interrelated factors that impact system safety.

The systems approach: A comprehensive way to improve patient safety

The systems approach takes the view that most errors reflect predictable human failings in the context of poorly designed systems (e.g., expected lapses in vigilance in the face of long work hours or predictable mistakes on the part of relatively inexperienced personnel faced with cognitively complex situations).[i]

Rather than focusing corrective efforts in a punitive manner, the systems approach seeks to identify situations or factors likely to give rise to human error and change the underlying systems of care to reduce the occurrence of errors or minimize their impact on patients.

There is no single solution or group that can offer a complete fix to this problem. However, different groups can, and should, make significant contributions to the solution. Large, complex problems require thoughtful, multifaceted responses. Preventing medical errors means designing the healthcare system at all levels to make it safer.

Our commitment to usability and safety at Allscripts

Allscripts has long recognized we must do our part to improve patient safety and we partner with a wide range of stakeholders to achieve that goal. In addition to comprehensive usability and safety practices during design and development, we also recognize the importance of advanced testing with the customization, configuration and ongoing maintenance of health IT. EHR vendors should do more to explain and deliver to healthcare organizations the workflows that we know are safe and efficient, and we should make organizations aware of the impact changes have on safety and usability.

Allscripts current usability and safety practices include deep user engagement, robust user-centered design processes (e.g., formative testing) and rigorous clinical test cases. With increased focus on usability and a commitment to continuous improvement, we will reduce the likelihood and impact of medical errors on patient safety.

[i] https://psnet.ahrq.gov/primers/primer/21/systems-approach

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