Patient safety issues continue to persist long after the go-live of an electronic health record (EHR) system, a recent study found.
For the study, published in the Journal of the American Medical Informatics Association, researchers looked at the patient-safety concerns with EHR systems after go-live. They examined approximately 100 investigations involving 344 EHR-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA).
The researchers found that the majority—74 percent—of the problems were related to the EHR’s technology itself. Many of those problems (70 percent) involved two or more model dimensions. The non-technical problems, researchers found, were workflow, policies, and personnel still interacted with the technical element such as software/hardware and user interface.
Overall, the technology concerns were typically boxed into four categories:
- Unmet data display needs (36 incidents)
- Improperly configured software (24 incidents)
- Transfer from one EHR component to another (17 incidents)
- Hidden dependencies – when one part of the EHR system is unexpectedly or unknowingly affected by the state or condition of another component
While some of the problems have straightforward origins, the authors write, such as simultaneous use of multiple instances of an EHR application by a single user, other problems are more complex. "Safety concerns we identified had complex sociotechnical origins and would need multifaceted strategies for improvement," the authors wrote. They suggest organizations with longstanding EHR systems as well as those just starting to implement should ensure they have good monitoring and risk assessment protocols in place to detect and mitigate these sorts of patient safety incidents.
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