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Research Letter
March 27, 2018

Electronic Health Record Usability Issues and Potential Contribution to Patient Harm

Author Affiliations
  • 1National Center for Human Factors in Healthcare, MedStar Health, Washington, DC
JAMA. 2018;319(12):1276-1278. doi:10.1001/jama.2018.1171

Electronic health record (EHR) usability, which is the extent that EHRs support clinicians in achieving their goals in a satisfying, effective, and efficient manner, is a point of frustration for clinicians and can have patient safety consequences.1,2 However, specific usability issues and EHR clinical processes that contribute to possible patient harm across different health care facilities have not been identified.3 We analyzed reports of possible patient harm that explicitly mentioned a major EHR vendor or product.4

This study was approved by the MedStar Health Institutional review board with an informed consent waiver. Patient safety reports, which are free-text descriptions of safety events, were analyzed from 2013 through 2016. Reports were retrieved from the Pennsylvania Patient Safety Authority database, which collects reports from 571 health care facilities in Pennsylvania, and from a large multihospital academic health care system in the mid-Atlantic, outside of Pennsylvania. Reports were voluntarily entered by health care staff, mostly nurses, and included several sentences describing the safety event, contributing factors, and categorization of effect on the patient. This categorization indicates whether the event reached the patient (meaning additional health care services were required), whether there was harm at the time of reporting, or the potential for harm to the patient. The harm categories were (1) reached the patient and potentially required monitoring to preclude harm, (2) potentially caused temporary harm, (3) potentially caused permanent harm, and (4) could have necessitated intervention to sustain life or could have resulted in death.