When it comes to electronic health records (EHRs) and patient safety, experience might be a great teacher, but it doesn't guarantee straight-A performance. According to a new study, even in longstanding EHR systems such as the one used by the Department of Veterans Affairs (VA) health care system, "many significant EHR-related safety concerns … remain."
In a study of investigations of EHR-related safety violations launched through the VA's Informatics Patient Safety office (IPS) from 2009 to 2013, researchers looked at 100 closed cases at 55 VA facilities. Of those cases, 74 involved unsafe technology, and 25 involved unsafe use of technology, which authors write "most commonly involved the dimensions of people, clinical content, workflow and communication, and human interface." A majority of cases (70%) involved both unsafe technology and unsafe use. The study was published online in the June 20 issue of JAMIA.
According to the study's authors, the problems documented in the research underscore the importance of constant vigilance for issues that could impact patient care—both at the purely technological level and within the "sociotechnical" realm, where users must interact with the technology.
Researchers were able to use the data to tease out 4 types of safety concerns represented by the cases:
Authors chose the VA system in part because of its standardized and well-documented approach to investigations of EHR safety problems, and in part because it was an early adopter of EHRs. The VA's level of experience, however, didn't eliminate the problems. "Having a mature EHR system clearly does not eliminate EHR-related safety concerns," authors write.
Tackling these problems will take not only vigilance but an understanding that EHRs involve both technological and human elements. "Our study suggests that technology-based solutions alone will only partially mitigate concerns and that interventions to improve EHR-related safety should encompass the people, organizations, systems, and policies that influence how EHRs are used," the report states.
APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs.
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