Study Links Poor EHR Usability to Patient Safety Issues

Sept. 13, 2023
Where users rated EHRs poorly for usability, those systems were less likely to flag drug-drug interactions, a patient’s allergies to drugs, duplicate orders or other harmful medication errors, study finds

Research published in JAMA Open Network found that hospital EHRs that are difficult to use are also less likely to catch medical errors that could harm patients.

A research team studied EHR systems in 112 U.S. hospitals, comparing results from an EHR experience survey taken by 5,689 clinicians with outcomes from an EHR safety evaluation tool. The Leapfrog CPOE EHR safety test examines whether medication orders that could potentially harm a patient properly triggers alert systems.

The study found that user experience strongly correlated with EHR safety. When users rated EHRs poorly, they said the systems were difficult to operate, hard to learn, slow, or inefficient. In cases where clinicians experienced those troubles, those EHR systems were less likely to flag drug-drug interactions, a patient’s allergies to drugs, duplicate orders, excessive dosing or other harmful medication errors.

“Poor usability of EHRs is the number one complaint of doctors, nurses, pharmacists, and most healthcare professionals,” said David Classen, M.D., the study’s corresponding author and a professor of internal medicine at University of Utah Health, in a statement. “This correlates with poor performance in terms of safety.” 

One explanation behind the link is a lack of quality control, Classen explained. Individual hospitals modify EHR operability to meet their specific needs. Some of these changes may be at the expense of safety. In addition, there are currently no standards for usability and safety.

“Our findings suggest that we need to improve EHR systems to make them both easier to use and safer,” Classen said. He collaborated on the study with senior author David Bates, M.D., at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, and scientists at University of California San Diego Health; KLAS Enterprises LLC; and University of California, San Francisco.

“Hospitals and health systems have spent more than $100 billion on EHRs over the last decade, and most believe that these systems are completely safe and usable but that is not necessarily the case,” Classen said. “Hospitals should annually perform a safety check on their system to assure it is safe.” 

Improving EHR systems in the long term may need a different approach, Classen added. Just as the Federal Aviation Administration, airline manufacturers, and airlines jointly monitor and improve airline software, a similar collaborative effort with EHR vendors, hospitals and clinicians may be what’s needed to optimize EHR software for user satisfaction, safety performance and to ultimately reduce medical errors.