Complex Electronic Record Safety Issues Surface Long After Launch
(HealthDay News) — Electronic health record-related safety concerns involving both unsafe technology and unsafe use of technology persist long after "go-live," according to a study published online June 20 in the Journal of the American Medical Informatics Association.
Derek W. Meeks, from the Michael E. DeBakey Veterans Affairs Medical Center in Houston, and colleagues analyzed completed investigations (n=100; August 2009 through May 2013) from the Informatics Patient Safety Office of the Veterans Health Administration using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety within electronic health record (EHR) systems. Emergent and recurring safety concerns common to multiple reports were identified through a framework analysis approach for qualitative data.
The researchers found that 74 investigations involved unsafe technology and 25 involved unsafe use of technology. Two or more model dimensions were involved in 70% of investigations. Safety concerns were produced by non-technical dimensions such as workflow, policies, and personnel interacting in a complex fashion with technical dimensions such as software/hardware, content, and user interface. The majority of safety concerns (94%) related to either unmet data-display needs in the EHR (such as displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or "hidden dependencies" within the EHR.
"Because EHR-related safety concerns have complex sociotechnical origins, institutions with longstanding as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them," the authors write.