Lack of quality controls creates difficult-to-use EHRs, raising risk of medication errors

by John R. Fischer, Senior Reporter | September 25, 2023
Health IT
EHR systems that are difficult to use are less likely to catch medication errors.
Due to a lack of quality controls, hospitals may be relying on difficult-to-use EHR systems that raise the risk of medical errors going undetected.

With no standards for usability and safety, individual hospitals and staff often modify their EHR systems to work in ways that meet needs, sacrificing safety in the process. Additionally, because of this, many may adopt EHR systems that end up being difficult to use.

In a new study, researchers in Utah, Massachusetts, and California found that these systems were less likely to flag medication errors, including drug-drug interactions, patient allergies to drugs, duplicate orders, excessive dosing, and other harmful medication errors.

“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,” said Dr. David Classen, corresponding author and a professor of internal medicine at University of Utah Health, in a statement.

In their study, Classen and his colleagues tested EHR systems in 112 hospitals across the U.S. and surveyed 5,689 clinicians on their experiences using these solutions. They then compared the survey findings with outcomes scored with the Leapfrog CPOE EHR safety test, which examines if harmful medication orders input into systems trigger alerts.

Despite medical experts originally predicting that widespread use of EHRs would reduce the risk of medication errors in hospitals, studies indicate that they have largely failed to do so, with poorly designed EHRs listed as a contributing factor. Classen and his colleagues found this in their own study in 2020.

One of the most dangerous risks that could occur is adverse drug interactions in patients. In 2022, a former nurse was charged with criminally negligent homicide after administering a paralyzing agent instead of a sedative to a patient undergoing an emergency PET scan for a brain bleed. She had disengaged a safety mechanism in the EHR system, preventing it from flagging the error and leading the patient to suffer cardiac arrest and partial brain death before dying two days later.

According to Classen, EHR vendors, hospitals, and clinicians should work together to optimize EHR software applications to ensure they are safe to use, facilitate user satisfaction, and reduce errors like this. “Hospitals should annually perform a safety check on their system to assure it is safe.”

The study was a collaboration of researchers and scientists from the University of Utah, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, University of California San Diego Health, University of California, San Francisco, and KLAS Enterprises.

The findings were published in the September 11 issue of JAMA Network Open.

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