Electronic Health Records: Usability and Unintended Safety Issues

Across the country, virtually all doctor’s offices and hospitals use electronic health records, or EHRs, to capture patient information. But EHR usability – their layout, design, customizations, and how they fit into different workflows—can impact patient safety.

In this video, you'll see one example of a health IT-facilitated error – how a computer auto-refresh results in a doctor pulling up the wrong record without even realizing it, and how it impacts the care a patient receives.

This is a fixable problem, but we need more research on how, when, and why these errors occur.

Learn more about how we can make health IT safer:


*Full Transcript*
Remember when going to the doctor’s office looked like this?

Now it looks more like this.

Across the country, more and more doctor’s offices are using electronic health records, or EHRs.

As digital records have become more common, unanticipated problems with design, workflow, training and how clinicians use them have contributed to patient harm.

To learn more, we talked to Medstar Health’s Dr. Raj Ratwani, a leading researcher on EHR usability and safety.

EHRs should make it easier and safer for clinicians to provide care for patients.

The sub-optimal usability of EHRs can lead to mistakes like selecting the wrong patient, ordering the wrong drug, or missing critical lab results.

Medstar Health’s Dr. Terry Fairbanks, who studies human factors in health care, explained how a computer auto-refresh error can cause a problem without the doctor realizing it.

Let’s take two patients. Martha Jones and Daniel Rodriguez, who come into the emergency department on the same day and have similar issues so they both need a chest x-ray.

When the doctor goes to see Martha Jones, they pull up the patient’s electronic health record to look at the X-ray.

And the doctor actually pulls up Daniel Rodriguez’s X-ray thinking that that it is Martha’s.

And this x-ray appears normal, so the doctor sends Martha home.

This all happened in a fraction of the second, so let’s slow it down and see what actually happened.

In between the first and second click, the database updates, and auto-refreshes.

So by the time the doctor finishes the second click, the X-ray icon his cursor was on now, belongs to Daniel Rodriguez.

Daniel’s x-ray looks fine.

On the other hand, this is Martha Jones's actual X-ray. You can see there's a large, white area here, which represents a pneumonia, which needs antibiotics. Without antibiotics, Martha could get much worse very quickly.

This is one example of a Health-IT facilitated error and there are many others.

This is a fixable problem, but currently there’s not enough research on how and why these errors occur.

All patients deserve the best care possible.

We need better data now on how, when and why these challenges arise so that we can all do a better job protecting our patients.

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