ver the last 9 years the US health care system has undergone an unprecedented transition from paper-based clinical record keeping to electronic health records (EHRs). This transition, incentivized by the Health Information Technology for Economic and Clinical Health Act passed in 2009, has many potential benefits for clinicians and patients, including improved efficiency, quality, and safety for many clinical processes.1Yet as with any major technology transition, there have also been challenges. One of the biggest challenges has been that many clinicians report that EHRs are difficult to use, require too much time to perform certain tasks, and create frustration in performing other tasks, especially those performed infrequently.2 EHR usability, which is the extent to which this technology can be used efficiently, effectively, and safely by clinicians to deliver care, has emerged as one of the most pressing issues in health care.3But even more important than clinician frustration is the association between EHR usability and potential harm to patients.4 Although these data are limited, and patient harm certainly occurred with paper records, examples of potential harm associated with EHRs include the incorrect medication or the correct medication and an incorrect dose being ordered for a patient because of a cluttered visual display or a setting with an incorrect default.4,5 A key piece of data, such as a markedly elevated blood pressure value, can be missed because that information is not prominently highlighted. These issues can result in errors and can cause harm and, possibly, death.4 Improving EHR usability and safety has been stressed as a top priority by federal government agencies, the Institute of Medicine, and the Joint Commission.6,7A major impediment to addressing usability and safety issues has been the inability of clinicians, researchers, and developers to communicate openly and share specific usability and safety challenges associated with EHR technology. Although medical device companies are required to share usability and safety issues, some EHR vendors have resisted sharing this informationeven information related to events that have resulted in substantial harm. Many contracts signed between EHR vendors and health care organizations include clauses that prevent health care organizations from sharing specific information about the EHR product. Such gag clauses require authorization from the vendor to share screenshots, videos, and any other information about the purchased EHR product.8 For example, some vendors specify that a clinician who identifies a critical usability and safety issue cannot share a visual example illustrating the issue, which could potentially prevent other clinicians from committing a similar error. A researcher studying usability and safety issues cannot publish a screenshot that may advance EHR design. A vendor may permit release after review of the content, but this process is often lengthy and permission may not be granted.

Source: Click here

Share this article

Facebook Comments