Study: EHR-Related Safety Issues Linger Long After Implementation

June 23, 2014 in News

Patient safety issues stemming from electronic health record systems continue long after implementation, according to a new study published in the Journal of the American Medical Informatics Association, Modern Healthcare reports (Rice, Modern Healthcare, 6/20).

Details of Study

For the study, researchers used the Veterans Health Administration’s Informatics Patient Safety Office to analyze EHR-related safety concerns.

According to Medical Daily, VA implemented its EHR system in 1999 and has since maintained a voluntary reporting system to collect and examine safety issues related to EHRs.

The researchers culled 100 closed patient safety investigations related to the EHR system that occurred between August 2009 and May 2013. The investigations covered 344 incidents (Scutti, Medical Daily, 6/20). The researchers reviewed the information for safety issues related to EHR technology, as well as human and operational factors, such clinical workflow demands, organizational guidelines and user behaviors (BMJ release, 6/20).

Study Findings

The researchers found that 74 events were related to unsafe EHR technology. The events included:

  • Computer glitches;
  • False alarms;
  • “Hidden dependencies,” or situations in which a change in one part of an EHR system inadvertently changes integral aspects in another part of the system; and
  • System failures.

The researchers found that 25 other events were related to the unsafe use of technology, such as misinterpreted screens or human input errors (Modern Healthcare, 6/20).

Overall, 70% of the investigations identified a mix of at least two reasons for each problem.

According to the study, commonly identified safety issues included:

  • Data transmission between different parts of the EHR system;
  • EHR information display issues, which was the most commonly identified problem; and
  • Problems related to software upgrades (Medical Daily, 6/20).

The study noted that the patient safety issues affected both new and longstanding EHR systems (BMJ release, 6/20).


The researchers wrote that organizations “with longstanding, as well as recent EHR implementations, should build a robust infrastructure to monitor and learn from” EHRs because “EHR-related safety concerns have complex socio-technical origins.”

Study co-author Hardeep Singh — a researcher at the Michael E. DeBakey VA Medical Center’s Center for Innovators in Quality, Effectiveness and Safety — said the issue is particularly concerning with the health care industry working to meet meaningful use and ICD-10 guidelines.

Under the 2009 federal economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.

Singh said, “People are mostly working to meet the federal requirements and not paying as much attention to the patient safety issues.” He added that organizations should look to the Office of the National Coordinator for Health IT’s SAFER Guides to better monitor EHR use (Modern Healthcare, 6/20).

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