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Letter to Congress:
Electronic Health Record (EHR) EHR Safety and Usability

The MedStar Health National Center for Human Factors in Healthcare authored the letter to Congress below urging them to ensure safety is prioritized in the EHR Reporting Program that is already mandated by the 21st Century Cures Act. You can read that Act here and search “Sec. 3009A. Electronic Health Record Reporting Program” for the related information.

We’re focused on encouraging collective action in 2019—the 10-year anniversary of the Health Information Technology for Economic and Clinical Health (HITECH) Act that prompted the near universal adoption of EHRs—so healthcare providers, patients, policymakers, and EHR vendors can all play our part in helping realize the tremendous potential of EHRs over the next decade.

While we are no longer collecting signatures for the letter, you can still join our contact list to stay posted about this effort and related work.

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Read the Letter

The Honorable Lamar Alexander
Chairman, Health, Education, Labor and Pensions Committee
United States Senate

The Honorable Frank Pallone
Chairman, House Energy and Commerce Committee
United States House of Representatives

The Honorable Patty Murray
Ranking Member, Health, Education, Labor and Pensions Committee
United States Senate

The Honorable Greg Walden
Ranking Member, House Energy and Commerce Committee
United States House of Representatives

Dear Chairman Alexander, Chairman Pallone, Ranking Member Murray, and Ranking Member Walden,

As part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, Congress encouraged hospitals, clinics, and physician offices to adopt electronic health records (EHRs) in order to improve the safety, quality, and efficiency of patient care. Congress envisioned that these systems would better enable doctors and nurses to treat their patients and deliver the best care possible. In many ways, EHRs are fulfilling that goal; however, a decade later a serious challenge remains. Poor EHR usability, which is the extent to which this technology can be used efficiently, effectively, and satisfactorily, is putting patient lives at risk. Usability is shaped by the design, development, and implementation of the technology.

As healthcare providers, patients, and health information technology professionals from across the country, we urge Congress to help address safety-related usability challenges through oversight of the administration’s implementation of a key, bipartisan provision from the 21st Century Cures (Cures) Act passed in 2016. We are signing this letter together to demonstrate that we have shared responsibilities and interests in the federal government taking action to advance the safe use of EHRs.

Suboptimal EHR usability has led to significant consequences that detract from the ability of these systems to fulfill their potential. Poor EHR usability promotes certain types of medical errors as physicians, nurses, and other clinicians use these systems to care for patients, and there is increasing evidence showing the association between usability issues and safety. A recent study examining 9,000 health information technology and medication safety events in three pediatric hospitals showed that inadequate EHR usability contributed to approximately a third of the errors, many of which resulted in patient harm. For example, because of a confusing EHR display, the weight of a child was entered incorrectly, leading to a significant medication overdose that resulted in harm. Poor EHR usability is also adding undue burdens on physicians and nurses, which is negatively impacting their well-being, pushing them to leave medicine, and increasing the likelihood of medical errorswhich also harms patients.

Congress has taken some steps to address this problem—but success depends upon effective implementation by the Office of the National Coordinator for Health Information Technology (ONC), the federal entity responsible for implementing and advancing the use of health information technology. In section 4002 of the Cures Act, Congress calls for the creation of an EHR Reporting Program, where ONC would collect and disseminate data on core EHR features, including usability. If developed effectively, this program can give providers, patients, the public, and even EHR vendors better information on how these systems operate to address any challenges—including usability and safety.

Congress should ensure that this program meets its intended goal in a way that improves the safety and quality of care. Specifically, Congress should ensure that ONC includes:

  1. Objective measures of safety as part of usability criteria given the body of evidence showing their close association.
  2. A method to allow clinicians and patients to directly report on EHR usability and safety as part of this program, so these reports can be analyzed and acted upon to reduce medical errors.

Poor EHR usability has contributed to harm for too many patients, and continues to introduce undue burdens on physicians, nurses, and other clinicians. Congress—and your committees specifically—can help address this public health and patient safety problem so that the use of EHRs improves care without leading to avoidable medical errors.


[Note: MedStar Human Factors Center leaders are in the process of sharing the signed letter with Congress.]


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