Study: It's still too easy to make mistakes in pediatric electronic health records

When it comes to giving kids the right dose of medication or properly timing their care, it's still too easy for doctors and nurses to make mistakes because of the usability of their electronic health record systems, according to a new study.

Raj Ratwani
Raj Ratwani, Ph.D. (MedStar Health)

In an examination of 9,000 pediatric safety event reports studied by MedStar Health's National Center for Human Factors in Healthcare, researchers found that more than a third had an EHR usability issue that affected the medication process and in about 19%—609 cases—the error reached the patient.

The study, which involved reports from MedStar, Children's Hospital of Philadelphia and Children's Hospital of Wisconsin, was published today in the November issue of Health Affairs.

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The study was funded by Pew Charitable Trusts and the Agency for Healthcare Research and Quality.

"We can’t think of children as tiny adults. Their needs are vastly different than adult patients, but historically what we’ve seen is many EHR vendors are not uniquely differentiating their products to meet the needs of pediatric populations,” said Raj Ratwani, Ph.D., director of MedStar's Human Factors Center, in an interview with FierceHealthcare.

Ratwani points out that the 9,000 reports were not selected at random but were chosen by keyword to show EHR reports that were likely to show an issue. But the study shows that 64% of the time there was an EHR issue, it was because of the usability of the system rather than from actual human error or engineering failures.

The most common failure was an over- or underdose of medication. That is a big problem because there is less margin for error in pediatric medicine. For example, particular functions such as ensuring the height and weight of a child are accurate and displayed prominently are crucial because weight-based dosing is so important in kids, said Ratwani, a lead author of the study. 

RELATED: Different usability standards are needed for pediatric electronic health records

"In pediatric populations, it’s absolutely essential. If you end up not giving the right medication dose because of a weight, you can actually kill children, unfortunately," Ratwani said. "Given that information, you need functionality and different safeguards in EHRs intended for the pediatric population. When we’re documenting their weight, when we’re documenting their height, that needs to be unbelievably accurate for pediatric populations."

The authors recommend that the federal Office of the National Coordinator for Health Information Technology—which was tasked with releasing a voluntary certification program for EHRs under the 21st Century Cures Act—include safety as part of the pediatric-focused voluntary certification program. They also recommend EHRs undergo test-case scenarios based on realistic clinical tasks in all phases of EHR development. They also said the Joint Commission should assess EHR safety as part of its hospital accreditation program.

The work echoes another publication earlier this year by Ratwani calling for the Office of the National Coordinator to institute specific standards to improve the safety of electronic health records used in pediatric settings.