As with other issues related to public safety and well-being, policymakers have a critical responsibility to understand the benefits and challenges of electronic health records, or EHRs, and push for action that will protect people while preparing us for the future. Following are suggestions of actions policymakers are uniquely positioned to take to improve EHR usability and safety.
Understand the issues and possible solutions
In February 2019, the Journal of the American Medical Association (JAMA) published an opinion piece that will be a timely and helpful start for getting up to speed and for taking action: “A Decade of Health Information Technology Usability Challenges and the Path Forward.” Additionally, our teams recently released a report with The Pew Charitable Trusts that can serve as a resource: “Ways to Improve Electronic Health Record Safety: Rigorous Testing and Establishment of Voluntary Criteria can Protect Patients.” It details several important actions for both EHR vendors and healthcare providers, among other key information. The MedStar Health National Center for Human Factors in Healthcare has also led or contributed to many other publications and reports pertaining to EHR usability and safety.
Establish a national database for usability and safety reporting
Just as the Food and Drug Administration (FDA) maintains the Manufacturer and User Facility Device Experience databases that allow vendors and users to report medical issues, the Office of the National Coordinator for Health Information Technology (ONC) can establish and maintain a central database of EHR usability and safety issues. It should be publicly accessible so all stakeholders, including patients, can report issues. ONC should consider how to leverage its forthcoming EHR Reporting Program to support this. Read the above February 2019 JAMA article for more information.
Encourage basic design standards
As in other high-risk industries, like aviation, basic design standards should be put in place based on human factors principles to promote good usability and bring consistency across EHR products. For example, one EHR may represent a critical lab result using a particular icon and specific colors, while another EHR may use entirely different icons and colors. These inconsistencies can lead to confusion and errors. Read the above February 2019 JAMA article for more information.
Improve EHR usability and safety transparency so products can be improved
Currently, many contracts between EHR vendors and healthcare providers include clauses that prevent healthcare organizations from sharing specific information about the EHR product. The 21st Century Cures Act of 2016 lays the groundwork for the ONC to establish regulations to prevent information blocking, which may include usability-related issues. This December 2018 JAMA viewpoint article describes key considerations that are important to resolve this EHR usability and safety issue. In fact, the bipartisan support for taking action on these issues dates back to 2015. Watch related footage from the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) and view select quotes on this page. Furthermore, objective and consistent measures of usability must be put in place, which the February 2019 JAMA article also addresses in more detail.
Promote safety testing of implemented EHR products
Once EHR products are implemented at healthcare provider sites, they should be safety tested before they are used in the patient care process. To promote this testing, The Joint Commission and other organizations should consider accreditation standards for hospitals. More information is available via the Pew report above (see PDF pages 23-54), and the July 2018 Journal of the American Medical Informatics Association (JAMIA) paper that prompted the collection of the videos on this website that show EHR usability and safety variability by provider site.
Participate in the American Medical Association’s (AMA) “EHR Connect” platform
EHR Connect brings together key stakeholders for enhanced collaboration around EHR development, usability, optimization, and interoperability for improved end-user experiences with EHRs. Join EHR Connect to share your voice, learn from others’ expertise and experiences, and access news, events, and resources on the topic.
Policymakers Calling for Action
Policymakers have long recognized the need to take action that helps advance EHR transparency, usability, and more—see the quotes below from 2015.
“The HELP Committee is squarely positioned to put the building blocks of our health IT infrastructure firmly in place, to improve transparency in the electronic health record marketplace, to empower providers to vote with their feet if they are not satisfied, and to identify best practices for deploying electronic health records as a care management tool.”
- U.S. Sen. Sheldon Whitehouse (RI) (Watch related video at 22:36)
“Physicians are having a very hard time finding a user-friendly electronic health…record system that meets their needs. And I was really concerned to hear recently that there is a study that found that many electronic health record vendors don’t even have a team dedicated to user-centered design. In fact, one vendor with over a billion dollars in annual review and over 6,000 employees has zero employees dedicated to user-centered design. So that’s why we need to make sure providers are able actually to vote with their feet when a system isn’t meeting their needs and more pressure from providers will actually force EHR companies to compete based on the quality of their systems.”
- U.S. Sen. Patty Murray (WA) (Watch related video at 1:00:08)