The relationship between EHR design and patient safety

Electronic health records (EHR) are designed to improve the quality of care a physician is able to provide for a patient. EHRs help reduce the issues that arise with paper medical records, including missing or incorrect information and delays caused by waiting for information to be transferred from one provider to another. As with any tool, however, care must be taken to use the EHR system properly in order to ensure it is a helpful tool and is not causing further issues for the patient’s safety.

The Electronic Health Record Association (EHRA) recently published Electronic Health Record Design Patterns for Patient Safety, which outlines potential areas of the EHR that might impact patient safety, including:

  • Medications
  • Alert Fatigue
  • Lab Results
  • Numeric Display
  • Displaying Text

The EHRA warns that confusion regarding medication information may result from the use of abbreviations or non-standard naming conventions. The association advises that “medications should be displayed in accordance to the FDA-approved list of ‘Generic Drug Names with Tall Man Letters’ and the Institute for Safe Medication Practices’ (ISMP’s) list of ‘Additional Drug Names with Tall Man Letters.’”

Alert fatigue occurs when providers and healthcare workers become desensitized to the volumes of alerts they receive every day. Prioritizing alerts within the EHR, based on the potential for patient harm, can help overcome alert fatigue. The highest priority, or critical, alerts should be interruptive, not allowing the healthcare worker to bypass them until they are read and acknowledged.

The EHRA advises that lab results must have a consistent display, regardless of where the results originate. In addition, they must be clearly separated according to previous and current results, and clearly flagged for abnormal results that require action.

Lab results and diagnostic tests often show up in numerical format. These can be hard to read and interpret correctly. The recommendation is to add a zero at the thousands level and in front of fractional numbers, for example, 1,000 and 0.25, instead of 1000 and .25.

Likewise, text needs to be easily read on-screen, to ensure accurate interpretation and to ensure appropriate instructions are provided to the patient. Shortcuts, such as abbreviations, can lead to errors in patient communications and to issues with patient safety.

The provider who follows these guidelines and uses care when inputting visit notes and other patient-related information can have a significant positive impact on the level of patient safety involved in reading and interpreting patient data in an EHR.