3 problems, solutions to EHR usability, patient safety

Providers often voice concerns and frustrations with EHRs, so how can the industry fix those issues? The Pew Charitable Trusts and Johns Hopkins Armstrong Institute for Patient Safety and Quality sought to start answering this question at a workshop in July. Seventy stakeholders, including EHR developers, hospital representatives, clinicians, patient safety advocates and the government, gathered to discuss core problems with EHR usability and ways to address those issues.

The stakeholders identified three overarching problems, and proposed accompanying solutions.

Problem 1: Inadequate testing requirements
Vendors need to conduct more tests and assessments to determine usability of EHRs. Currently the ONC only requires summative testing once an EHR has been designed, meaning usability testing looks at how easily providers can perform various functions. "Requirements are limited to evaluation of EHR functionality — for example, simply assessing whether a clinician can successfully order a medication, rather than examining how likely it is for a clinician to order a wrong medication or dosage," according to Pew.

Instead, the stakeholders at the meeting suggest vendors and their products should undergo testing at multiple points in the development process: during the design process to make updates to the interface and workflows as they are being developed, summative testing that currently is in place, and post-implementation testing that finds problems that were not previously identified.

Problem 2: Insufficient measures of EHR safety and usability
According to Pew, there are no widely accepted metrics for measuring EHR performance regarding patient safety or quality measures that also allow them to track improvements.

Industry stakeholders should double down on efforts to develop such measures, according to Pew. Once these are established, providers can address weaknesses in their systems and work with developers to improve them.

Problem 3: Inability to learn from EHR usability and safety issues
Meeting attendees said it is difficult to share lessons learned and developmental insights regarding EHRs with other hospitals. They said they often fear violating nondisclosure or intellectual property clauses in their vendor contracts.

Stakeholders at the meeting suggested creating an organization where providers can share such experiences without fear of violating the gag clauses. Specifically, they suggest Congress passes legislation to designate such an entity, financially support it, outline protections for vendors and establish ways to share best practices.

"By raising the bar on testing for usability, measuring performance and opening up ways to share learning on problems and solutions, stakeholders can make progress on EHR usability and safety and help clinicians deliver safe, patient-centered, high-quality care," according to Pew.

More articles on EHRs:

In emergency preparedness rule, EHRs not required as documentation tool
The ethics of labeling 'frequent fliers' in the EHR
Jonathan Bush: We're using old technology to measure how bad new technology is

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