Summary
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
Keywords
Interoperability - patient safety - electronic health records
