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. 2020 May 1;3(5):e205547.
doi: 10.1001/jamanetworkopen.2020.5547.

National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018

David C Classen  1 , A Jay Holmgren  2 , Zoe Co  3 , Lisa P Newmark  4 , Diane Seger  4 , Melissa Danforth  5 , David W Bates  3   4   6
Affiliations

National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018

David C Classen et al. JAMA Netw Open. .

Abstract

Importance: Despite the broad adoption of electronic health record (EHR) systems across the continuum of care, safety problems persist.

Objective: To measure the safety performance of operational EHRs in hospitals across the country during a 10-year period.

Design, setting, and participants: 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.

Exposure: 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.

Main outcomes and measures: 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.

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Classen reported receiving grants from the Gordon and Betty Moore Foundation and Robert Wood Johnson Foundation and serving as an employee of Pascal Metrics, a federally certified patient safety organization. outside the submitted work. Dr Bates reported personal fees from EarlySense and CDI NEGEV; equity from Valera Health, CLEW, MDClone, and Aesop; and research funding from IBM Watson Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Basic and Advanced Clinical Decision Support Test Scores Over 10 Years
Figure 2.
Figure 2.. Category Test Scores Over Time
Figure 3.
Figure 3.. Summary of Hospital Overall Scores by Electronic Health Record Vendor
CPOE indicates computerized physician order entry; Whiskers, SD.
See this image and copyright information in PMC

Comment in

References

    1. Bates DW, Singh H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Aff (Millwood). 2018;37(11):1736-1743. doi:10.1377/hlthaff.2018.0738 - DOI - PubMed
    1. US Department of Health and Human Services, Office of the National Coordinator for Health Information Technology 2018 Report to Congress: annual update on the adoption of a nationwide system for the electronic use and exchange of health information. Accessed April 29, 2020. https://www.healthit.gov/sites/default/files/page/2018-12/2018-HITECH-re...
    1. Committee on Patient Safety and Health Information Technology, Institute of Medicine . Health IT and Patient Safety: Building Safer Systems for Better Care. National Academies Press; 2012. - PubMed
    1. Kilbridge PM, Welebob EM, Classen DC. Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. Qual Saf Health Care. 2006;15(2):81-84. doi:10.1136/qshc.2005.014969 - DOI - PMC - PubMed
    1. Metzger J, Welebob E, Bates DW, Lipsitz S, Classen DC. Mixed results in the safety performance of computerized physician order entry. Health Aff (Millwood). 2010;29(4):655-663. doi:10.1377/hlthaff.2010.0160 - DOI - PubMed

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