MedStar Health, AMA launch campaign to improve EHR usability, safety

It's been a decade since Congress passed the landmark Health Information Technology for Economic and Clinical Health (HITECH) Act, along with a $40 billion investment in encouraging health IT implementation.

But while adoption of EHRs has come a long way, usability remains stubbornly suboptimal, and that's contributing to clinician burnout and is causing patient harm, health IT leaders say,

“We are at a stage now where there is overwhelming evidence that shows the association between the usability of EHRs and patient safety,” said Raj Ratwani, Ph.D., an EHR safety researcher and director of the MedStar Health National Center for Human Factors in Healthcare, in an interview with FierceHealthcare.

To spur the industry to act, Maryland-based MedStar and the American Medical Association (AMA) launched an advocacy campaign called “Everybody Has Responsibilities.” The goal, they say, is to raise awareness about the patient safety risks associated with poor EHR usability and to spur industry stakeholders, including vendors, researchers, policymakers, healthcare organizations, clinicians and patients, to take action.

“This shared commitment is imperative because another decade of poor usability and related patient safety challenges would be unbearable, especially for patients,” MedStar and AMA researchers wrote in a recent JAMA article, which also lays out the framework for improving EHR usability.

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Central to this campaign, MedStar is gathering signatures on a letter to Congress calling for federal lawmakers to address safety-related usability challenges through oversight of the administration’s implementation of key provisions from the 21st Century Cure Act. As part of the Cures Act, the Office of the National Coordinator for Health IT (ONC) is charged with creating an EHR Reporting Program. MedStar and other industry stakeholders are calling for Congress to ensure that this program includes safety as part of usability criteria and are also urging the development of a national database for usability and safety reporting. Industry stakeholders have until Feb. 28 to sign the letter.

Industry organizations have voiced support for the campaign, including the American Medical Informatics Association, which says it supports creating a national public or private center for health IT safety. Unlike other industries, the health IT industry currently does not have a method for clinicians, or patients, to openly report safety or usability issues with EHR software, said Ratwani.

“Part of the issue is that in the contracts between EHR vendors and many providers are what are commonly termed gag clauses, and that contract language prevents the open discussion and sharing of critically important usability and safety issues,” he said. “EHR safety must be a priority for all stakeholders. Nearly every high-risk industry promotes the sharing of safety information to foster improvement, and health information technology should be no different.”

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Persistent poor EHR usability issues can be traced back to several factors, Ratwani said. While the early federal investment in health IT as a result of the HITECH Act spurred adoption, it also created an aggressive timeline for vendors. “There wasn’t as much focus on the usability of the software tool itself,” he said. What’s more, the guidelines and regulations put in place to promote usability have not been rigorous enough, he noted, and even with the policies in place, some vendors are not fully adhering to them.

A recent study examining 9,000 health IT and medication safety events in three pediatric hospitals showed that inadequate EHR usability contributed to approximately a third of the errors, many of which resulted in patient harm. For example, because of a confusing EHR display, the weight of a child was entered incorrectly, leading to a significant medication overdose that resulted in harm.

MedStar and AMA teamed up to develop a new website,, featuring videos from the clinician’s point of view that demonstrate the EHR usability issues clinicians face on a daily basis and the potential risks to patient safety. The videos, featuring both real usage and simulated situations, demonstrate common challenges with data entry, visual display, and workflow support when using EHRs. MedStar built the video website based on research they conducted recently on the usability of Cerner and Epic products, which comprise more than 50% of the market. Those research findings were published in the Journal of the American Medical Informatics Association.  

“We saw, for particular tasks, error rates ranging from 10% to 50% at times,” Ratwani said. “The goal of our campaign is to really raise awareness of these issues and help the public understand that EHRs are central to how they receive care. It’s also to show that these errors happen frequently.”

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The campaign is a call to action for all industry stakeholders—healthcare providers, patients, policymakers, and vendors—he said. “Patients need to understand that EHRs are integral to their care, but some fixes need to happen, and we’d like to see patients get more involved in the conversation.”