| February 23, 2019

Medstar and AMA Tackle Usability Issues Tied To EHR Systems

Nqaba Matshazi

Nqaba has been working as an investigative journalist for the last 10 years. He has written for various media outlets across the world. Nqaba has been working as an investigative journalist for the last 10 years. He has written for various media outlets across the world.

Physicians have frequently vented their frustrations with inefficient electronic health record (EHR) systems, saying this was often leads to exhaustion and depression among health practitioners.

In an effort to show just how frustrating this can be, Medstar Health National Center for Human Factors in Healthcare and the American Medical Association (AMA) have teamed up to launch a campaign that seeks to illustrate, from a physician’s point of view, the risks and challenges caused by poor EHR usability.

Campaign to show physicians’ point of view

“We are at a stage now where there is overwhelming evidence that shows the association between the usability of EHRs and patient safety,” Raj Ratwani, an EHR safety researcher and director of the MedStar Health National Center for Human Factors in Healthcare, was quoted saying.

The aim of the campaign, known as “Everybody Has Responsibilities” — wordplay on the EHR acronym– is to raise awareness about patient safety risks associated with poor EHR usability and to spur industry stakeholders, including vendors, researchers, policymakers, healthcare organizations, clinicians and patients, to take action.

To illustrate their point, the organizations have set up an advocacy website — ehrseewhatwemean.org — where there are a number of videos showing how a poor EHR user experience for physicians poses a safety risk to patients and could compromise the quality of care.

On the website, Medstar and the AMA said that although EHRs had become ubiquitous, the technologies presented “new kinds of risks to the safety and quality of care, due to serious challenges with EHR usability, or the effectiveness and efficiency of using the technology. These well documented issues can lead to clinician burnout and errors that directly impact patient safety.”

Gag clauses worry health sector

Medstar and AMA said they were “sharing rare videos of real and simulated EHR usability challenges,” that they hoped would jolt EHR vendors, healthcare providers and policymakers into “improving EHR design, development, and implementation to eliminate known patient safety risks and make them easier to use.”

An issue that did not sit well with Medstar was the inclusion of clauses in contracts between EHR vendors and healthcare providers that prevent healthcare organizations from sharing specific information about EHR products.

“Part of the issue is that in the contracts between EHR vendors and many providers are what are commonly termed gag clauses, and that contract language prevents the open discussion and sharing of critically important usability and safety issues. EHR safety must be a priority for all stakeholders. Nearly every high-risk industry promotes the sharing of safety information to foster improvement, and health information technology should be no different,” Ratwani from Medstar said.

The health sector has given the campaign widespread support, with the American Medical Informatics Association pushing for the creation of a national public or private center for health IT safety.

A letter to Congress

The bedrock of the campaign is a letter to Congress, in which Medstar has urged lawmakers to ensure safety is prioritized in the EHR Reporting Program that is already mandated by the 21st Century Cures Act.

In the letter, Medstar bemoans suboptimal EHR usability, saying this had led to significant consequences that detract from the ability of these systems to fulfill their potential.

“Poor EHR usability promotes certain types of medical errors as physicians, nurses, and other clinicians use these systems to care for patients, and there is increasing evidence showing the association between usability issues and safety. A recent study examining 9,000 health information technology and medication safety events in three pediatric hospitals showed that inadequate EHR usability contributed to approximately a third of the errors, many of which resulted in patient harm,” the letter reads.

Medstar added that poor EHR usability adds undue burdens on physicians and nurses, which negatively affect their well-being, pushing them to leave medicine, and increasing the likelihood of medical errors.

Previous research buttresses this point, with a study by the the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and the Massachusetts Health and Hospital Association (MHA), pointing out that poorly designed digital health records and quality metrics meant that doctors devoted more time to tasks that did not directly benefit patients and that this had contributed to physician burnout, which has been described as an epidemic in the report.

The use of digital health records has grown at an astounding pace over the past decade since Congress signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act in February 2009.

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