Abstract
Despite the broad adoption of electronic health record (EHR) systems across the continuum of care, safety problems persist. To measure the safety performance of operational EHRs in hospitals across the country during a 10-year period. This case series included all US adult hospitals nationwide that used the National Quality Forum Health IT Safety Measure EHR computerized physician order entry safety test administered by the Leapfrog Group between 2009 and 2018. Data were analyzed from July 1, 2018 to December 1, 2019. The Health IT Safety Measure test, which uses simulated medication orders that have either injured or killed patients previously to evaluate how well hospital EHRs could identify medication errors with potential for patient harm. Descriptive statistics for performance on the assessment test over time were calculated at the overall test score level, type of decision support category level, and EHR vendor level. Among 8657 hospital-years observed during the study, mean (SD) scores on the overall test increased from 53.9% (18.3%) in 2009 to 65.6% (15.4%) in 2018. Mean (SD) hospital score for the categories representing basic clinical decision support increased from 69.8% (20.8%) in 2009 to 85.6% (14.9%) in 2018. For the categories representing advanced clinical decision support, the mean (SD) score increased from 29.6% (22.4%) in 2009 to 46.1% (21.6%) in 2018. There was considerable variation in test performance by EHR. These findings suggest that despite broad adoption and optimization of EHR systems in hospitals, wide variation in the safety performance of operational EHR systems remains across a large sample of hospitals and EHR vendors. Hospitals using some EHR vendors had significantly higher test scores. Overall, substantial safety risk persists in current hospital EHR systems.
Highlights
The Institute of Medicine’s 1999 report, “To Err is Human” brought into the public eye the issue of medical errors in modern medicine and estimated that approximately 98 000 deaths and 1 000 000 inpatient injuries occur annually in the US because of medical errors.[1]
There was considerable variation in test performance by electronic health record (EHR). These findings suggest that despite broad adoption and optimization of EHR systems in hospitals, wide variation in the safety performance of operational EHR systems remains across a large sample of hospitals and EHR vendors
Key Points Question How did safety performance of electronic health record systems (EHRs) change in the US from 2009 to 2018?. In this case series using 8657 hospital-year observations from adult hospitals nationwide that used the National Quality Forum Health information technology (IT) Safety Measure, a computerized physician order entry and EHR safety test, from 2009 to 2018, mean scores on the overall test increased from 53.9% in 2009 to 65.6% in 2018
Summary
In the decades that followed, implementation of EHRs with the use of CPOE and associated CDS accelerated. This effort was driven in part by the Health Information Technology for Economic and Clinical Health Act, which drove the development of meaningful use incentives for EHR adoption.[2] A subsequent Institute of Medicine report on patient safety and health information technology (IT) published in 2012 reviewed the progress in adoption of EHRs and found the adoption of EHRs had not yet led to expected significant improvements in medication safety.[3] That report made recommendations about improving medication safety through more effective development and use of EHRs with CDS. The particular concern was that organizations purchase EHRs and medication safety tools from separate vendors and have great latitude in how they implement and maintain them, so substantial variation in safety performance could be present
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