EHR usability, safety issues demonstrate need for pharmacist involvement

Researchers noted medication administration as main factor to possible patient harm from EHR

Challenges to usability of electronic health records (EHRs) may contribute to potential harm to patients, say researchers in a letter to JAMA published online March 27. In the study, researchers at MedStar Health’s National Center for Human Factors reviewed patient safety reports—free-text descriptions of safety events voluntarily entered by health care staff—retrieved from the Pennsylvania Patient Safety Authority database. They found that of the 1.735 million reported safety events from 2013 through 2016, 1,956 events that were reported as contributing to possible patient harm mentioned an EHR vendor or product.

Furthermore, 557 reports explicitly suggested that EHR usability contributed to possible patient harm. The researchers noted which processes were affected by EHR usability problems, with medication administration (37%) second only to order placement (38%). The remaining processes affected were review of results (16%) and documentation (9%).

Many of the examples included in the research involved unusual situations, such as a case in which a patient had received an extra dose of diltiazem because the system interpreted a dose given by a night nurse at 5:30 a.m. as being given the day before. At 10:00 a.m., another task for dosing popped up because the order was written as daily, so the patient was given another dose at 12:30 p.m.

Such results don’t surprise Shelly Spiro, RPh, FASCP, executive director of the Pharmacy Health Information Technology (HIT) Collaborative, who was not involved in the research.

“The system was doing everything it was supposed to. The anomaly was that the dose had to be adjusted, but nobody followed through to make sure the next dose was at the right time or that the first dose needed to be entered a certain way. Problems can come in when the patient doesn’t fall into the normal process.”

Spiro said this serves as a caution against overreliance on EHRs for medication management. “Good clinicians and good pharmacists take the time to make their evaluations and decisions in patient-specific ways. They can’t program the system to think in the same way that a pharmacist is trained to think when something unique is happening to that particular patient.”

Scott Nelson, PharmD, MS, assistant professor of biomedical informatics and clinical director of health IT at Vanderbilt University Medical Center in Nashville, agrees.

Because pharmacists work with EHRs as part of medication management, reconciliation, and dispensing, their information and workflow needs should be considered in EHR design and implementation— but they often aren’t. A paper by Nelson and his colleagues published in the Journal of the American Medical Informatics Association last year noted that although the EHR allows for opportunities to support pharmacists’ work, there are few tools in the systems specifically for pharmacists.

“EHRs are such complex systems with so many different people in so many different workflows, but it seems pharmacy has been left out or left behind with usability,” Nelson said.

Nelson added that pharmacists should be involved in reviewing HER usability, not only for their own work, but to help clinicians across the board provide better care.

For the full article, please visit for the June 2018 issue of Pharmacy Today.