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An Analysis of Patient Safety Incident Reports Associated with Electronic Health Record InteroperabilityFunding This work was supported by grant number 5 R01 HS023701–02 from the Agency for Healthcare Research and Quality to Raj M. Ratwani.
15 January 2017
accepted: 16 March 2017
21 December 2017 (online)
Background: With the widespread use of electronic health records (EHRs) for many clinical tasks, interoperability with other health information technology (health IT) is critical for the effective delivery of care. While it is generally recognized that poor interoperability negatively impacts patient care, little is known about the specific patient safety implications. Understanding the patient safety implications will help prioritize interoperability efforts around architectures and standards.
Objectives: Our objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports to understand the health IT systems involved, the clinical care processes impacted, whether the incident occurred within or between provider organizations, and the reported severity of the patient safety events.
Methods: From a database of 1.735 million patient safety event (PSE) reports spanning multiple provider organizations, 2625 reports that were indicated as being health IT related by the event reporter were reviewed to identify EHR interoperability related reports. Through a rigorous coding process 209 EHR interoperability related events were identified and coded.
Results: The majority of EHR interoperability PSE reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems as opposed to the EHR sending information to other systems. The majority of EHR interoperability challenges were within a provider organization and while many of the safety events reached the patient, only a few resulted in patient harm.
Conclusions: Interoperability efforts should prioritize systems in pharmacy, laboratory, and radiology. Providers should recognize the need to improve EHRs interfacing with other health IT systems within their own organization.
Citation: Adams KT, Howe JL, Fong A, Puthumana JS, Kellogg KM, Gaunt M, Ratwani RM. An analysis of patient safety incident reports associated with electronic health record interoperability. Appl Clin Inform 2017; 8: 593–602 https://doi.org/10.4338/ACI-2017-01-RA-0014
Human Subjects Protections
This study was approved by the Institutional Review Board (protocol #2014–101).
- 1 Henry J, Pylypchuk Y, Searcy T, Patel V. Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals. 2008–2015. ONC Data Brief, no 35. 2016: 35.
- 2 HIMSS. HIMSS Dictionary of Healthcare Technology Terms, Acronyms, and Organizations. 3rd ed. Taylor & Francis; 2015
- 3 ONC. Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap. 2014;1–77. Available from: http://www.healthit.gov/sites/default/files/nationwide-interoperability-road map-draft-version-1.0.pdf
- 4 Zhou Y, Ancker JS, Upadhye M, McGeorge NM, Guarrera TK, Hegde S, Crane PW, Fairbanks RJ, Bisantz AM, Kaushal R, Lin L. The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study. Inform Prim Care 2013; 21 (01) 21-29. Available from: http://dx.doi.org/10.14236/jhi.v21i1.36
- 5 Rosenbaum L. Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine. N Engl J Med 2015; 373 (17) 1585-1588.
- 6 Obama B, Romney M. Health Care Reform and the Presidential Candidates. N Engl J Med 2012; 367 (15) 1377-1381. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:New+engla+nd+journal#0 PMID: 20573919
- 7 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The Value of Health Care Information Exchange and Interoperability. Heal Aff. 2005 Jan-Jun(Suppl Web Exclusives): W5–10-W15–18.
- 8 Magrabi F, Ong M-S, Runciman W, Coiera E. An analysis of computer-related patient safety incidents to inform the development of a classification. J Am Med Informatics Assoc 2013; 17 (06) 663-670.
- 9 Aspden P, Corrigan JW, Erickson SM. Patient Safety Reporting Systems and Applications. Patient Saf Achiev a new Stand care. Washington, D.C.: National Academy Press; 2004: 250-278.
- 10 Rosenthal J, Booth M. Maximizing the Use of State Adverse Event Data to Improve Patient Safety. Portlan, ME: 2005
- 11 Clarke JR. How a system for reporting medical errors can and cannot improve patient safety. Am Surg 2006; 72 (11) 1088– 91-48.
- 12 Boxwala AA, Dierks M, Keenan M, Jackson S, Hanscom R, Bates DW, Sato L. Organization and Representation of Patient Safety Data: Current Status and Issues around Generalizability and Scalability. JAMIA 2004; 11 (06) 468-478.
- 13 Magrabi F, Ong M-S, Runciman W, Coiera E. Using FDA reports to inform a classification for health information technology safety problems. J Am Med Informatics Assoc 2012; 19 (01) 45-53.
- 14 Mardon R, Olinger L, Szekendi M, Williams T, Sparnon EM, Zimmer K. Health Information Technology Adverse Event Reporting: Analysis of Two Databases. 2014