View source for An analysis of electronic health record-related patient safety concerns

This is a review on Meeks et al. (2014) article, “An analysis of electronic health record-related patient safety” <ref name="EHR AND PATIENT SAFETY"> Meeks, D. W., Smith, M. W., Taylor, L., Sittig, D. F., Scott, J. M., & Singh, H. (2014). An analysis of electronic health record-related patient safety concerns. Journal of the American Medical Informatics Association: JAMIA, 21(6), 1053–1059. http://doi.org/10.1136/amiajnl-2013-002578</ref>.

=Background and Objective=
This article describes the issues related to [[EMR|electronic health records (EHR)]] related health concerns at a large integrated healthcare system – Department of Veterans Affairs (VA) which includes more than 1700 care sites.  The benefits of electronic medical or health records cannot be understated and have been highlighted in the following review “[[EMR Benefits: Healthcare quality]]”.  

According to the article by Meeks et al (2014) <ref name="EHR AND PATIENT SAFETY"/>,  [http://en.wikipedia.org/wiki/Health_information_technology health information technology (HIT)] such as EHR’s does not only improve patient safety and efficiency but on the flip side it may introduce new patient safety concerns.  Some of the reasons given for this center around [[Usability|usability]], disruptions of clinical processes, and unsafe work practices in order to bypass the new technology. 
The issue of patient safety with regards to [[Usability|usability]] of EHR’s was also discussed in the following review “[[Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA]]”.

==Methods==
Authors retrospectively analyzed 100 consecutive completed investigation EHR-Related patient safety concern reports from the [https://mobile.va.gov/node/241 Informatics Patient Safety Office (IPS) of the Veterans Health Administration (VA)]. These reports were between August 2009 and May 2013 and selected from 344 reported incidents.  The analysis looked at both technical and non-technical aspects of patient safety using an eight dimension sociotechnical model to categorize incidents. In addition patient safety concerns were categorized into 3 patient safety ‘’phases’’ related to the EHR implementation or use.

===[http://en.wikipedia.org/wiki/Patient_safety/''Patient safety''] Phases===
 ''' * Phase 1: ''Concerns related to inherently unsafe technology or technology failures'' '''
  '''* Phase 2: ''Concerns related to unsafe or inappropriate use of technology'''''
 ''' * Phase 3: ''Concerns related to lack of using technology to monitor for potential safety concerns before harm occurs'''''

===Sociotechnical Dimensions===
# ''Hardware and software: the computing infrastructure used to power, support, and operate clinical applications and devices''
#* Most of the safety issues reported were related to this category
#* Primarily Phase 1 concerns
#  ''Clinical content: the text, numeric data, and images that constitute the language of clinical applications''
#* The second highest category in terms of safety concerns reported.
#* Primarily Phase 1 and Phase 2 concerns
#  ''Workflow and communication: processes to ensure that patient care is carried out effectively''
#* The third highest category in terms of safety concerns reported.
#* Primarily Phase 1 concerns
#  ''Human-computer interface: all aspects of technology that users can see, touch, or hear as they interact with it''
#* This was the fourth highest category in terms of safety concerns reported.
#*Primarily Phase 1 and Phase 2 concerns
# ''People: everyone who interacts in some way with technology, including developers, users, IT personnel, and informaticians''
#* Primarily Phase 2 concerns
# ''Internal organizational features: policies, procedures, work environment, and culture''
# ''External rules and regulations: federal or state rules that facilitate or constrain preceding dimensions''
# ''System measurement and monitoring: processes to evaluate both intended and unintended consequences of health IT implementation and use''

==Results==
The findings showed that 74 of the cases selected were related to unsafe technology (Phase 1) while 25 related to the unsafe use of technology (Phase 2).  However majority (70%) related to more than one category. The authors further classified the concerns from these categories into four main types that had the potential to affect multiple patients.

* ''Unmet data-display needs which accounted for 94% of the safety concerns (i.e. Mismatch between information needs and content display)''
* ''Concerns related to both intended and unintended software modifications''
* ''Concerns related to system–system interfaces (i.e. due to failure of interface between EHR systems''
* ''Concern of hidden dependencies in distributed systems (i.e. a component of the EHR that is unexpectedly or unknowingly affected by the state or condition of another component)''

==Discussion and Comments==
The results of this study highlighted four predominant types of safety concerns and the authors suggest procedures for mitigating these.  These findings may be helpful to Institutions seeking to implement EHR systems. The authors also suggest that those seeking to implement EHRs include a system that allows them to monitor and learn from EHR related safety concerns. This study represents an important consideration for Institutions using EHRs and highlights the importance of obtaining feedback from all key stakeholders prior to implementation of an EHR system.  It shows how issues related to [[Usability#Usability_in_EHRs|usability in EHR’s]] can impact patient safety.

==Related articles==
Eight Rights of Safe Electronic Health Record Use.<ref name="Dean">Sittig,D.F.,Singh H. Eight Rights of Safe Electronic Health Record Use.JAMA. 2009;302(10):1111-1113 (doi:10.1001/jama.2009.1311). Retrieved from http://jama.ama-assn.org/cgi/content/full/302/10/1111</ref>

Evaluating the impact of an integrated computer-based decision support with person-centered analytics for the management of asthma in primary care: a randomized controlled trial.<ref name="Patel, 2015">Tamblyn et al. Evaluating the impact of an integrated computer-based decision support with person-centered analytics for the management of asthma in primary care: a randomized controlled trial. JMIR Med Inform . 2015: Feb.
http://www.jmir.org/2015/2/e14/</ref>

==References==
<references/>

[[Category:Reviews]]
[[Category:Usability]]
[[Category:HI5313_SP15]]
[[Category:EMR]]