[{"innerBlocks":[],"name":"core\/freeform","postId":1284,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"The largest healthcare provider in the Baltimore-Washington metropolitan area is urging Congress to take action when it comes to the link between electronic health record usability and patient safety.

MedStar Health has drafted a letter<\/a> to Senate and House committees calling on lawmakers to \u201caddress safety-related usability challenges\u201d and to implement a key provision of the 21st Century Cures Act.

While Congress has taken steps to address this problem, MedStar\u2019s letter contends that \u201csuccess depends upon effective implementation by the Office of the National Coordinator for Health Information Technology\u201d of Section 4002 of the Cures Act, which directs the \u201ccreation of an EHR Reporting Program, where ONC would collect and disseminate data on core EHR features, including usability.\u201d

\u201cIf developed effectively, this program can give providers, patients, the public and even EHR vendors better information on how these systems operate to address any challenges\u2014including usability and safety,\u201d the MedStar letter adds.

The not-for-profit health system, which operates 10 hospitals in the Baltimore-Washington region, is asking healthcare stakeholders to sign the letter to Congress by February 28 to lend support to the initiative.

\u201cPoor EHR usability promotes certain types of medical errors as physicians, nurses, and other clinicians use these systems to care for patients, and there is increasing evidence showing the association between usability issues and safety,\u201d states the letter.

Also See<\/b>: EHR usability issues pose safety risk to pediatric patients<\/a>

The American Medical Informatics Association issued a statement supporting the effort and urged other industry stakeholders to sign the letter to Congress.

\u201cWe have a fractured and loosely connected system to understand when health IT negatively impacts patient care, how such harms could have been avoided, and what changes to usability, design and implementation are necessary to mitigate such shortcomings in the future,\u201d said Doug Fridsma, MD, AMIA\u2019s president and CEO. \u201cThis inability to understand how health IT impacts safety across settings of care is why AMIA supports the establishment of a national public\/private center, or collaborative, on health IT safety meant to convene, analyze and disseminate information to improve the safety and safe use of health IT.\u201d

Raj Ratwani, director of the MedStar Health National Center for Human Factors in Healthcare, which authored the letter to Congress, contends that a central reporting system is needed \u201cso that clinicians, patients, and any other stakeholder that sees an EHR usability and safety issue can report it into that database.\u201d

On Monday, a viewpoint article<\/a> co-authored by Ratwani was published in JAMA calling for the creation of a national reporting system much like the Food and Drug Administration\u2019s Manufacturer and User Facility Device Experience database for medical devices.

\u201cTo create such a reporting system, clinicians must be permitted to report and illustrate various types of usability issues, and resources must be allocated by the ONC, HIT vendors and healthcare organizations for appropriate investigation into root causes of these issues so they can be resolved,\u201d states the article. \u201cThe 21st Century Cures Act, passed with bipartisan support in 2016, may provide the legal authority and regulatory framework to establish this database through ONC, which should be accessible by the public and allow anyone to report issues.\u201d

According to Ratwani, this kind of data must be available for analysis but he charges that \u201cgag clauses\u201d in contracts between EHR vendors and provider organizations \u201chas prevented open discussion of these kinds of issues and challenges.\u201d

However, in a written statement, the Electronic Health Record Association pointed out that EHR developers have a longstanding commitment to patient safety.

\u201cThe principles of the 2016 EHR Developer Code of Conduct promote patient safety,\u201d according to the group. \u201cEHRA also actively monitors, contributes and is committed to engagement with federal agencies, PSOs, trade associations, professional societies, liability carriers, academics and other stakeholders to collaborate on efforts to promote a culture of safety in health IT and evolve a non-punitive national learning system.\u201d

Nonetheless, MedStar and the American Medical Association have made available for the first time videos from the clinician\u2019s point of view that the provider organizations say demonstrate the risks and challenges caused by poor EHR usability.

The videos are posted on a website, EHRSeeWhatWeMean.org<\/a>, based on recent MedStar research<\/a> in partnership with the AMA regarding the EHR <\/b>usability of the two major health IT vendors with the largest market share\u2014Cerner and Epic. In the study, emergency medicine physicians from four health systems\u2014two using Cerner and two using Epic\u2014were given common tasks to perform in standardized clinical scenarios <\/b>mimicking real patient cases.

\u201c<\/b>What we found was huge variability in the time and error rates while completing those tasks,\u201d said <\/b>MedStar\u2019s Ratwani. <\/b>\u201cWe presented that information in a journal publication in 2018, and now we\u2019re showing the video snippets of those usability challenges.\u201d

Ratwani added that MedStar asked permission from the Cerner sites to show the actual video, which the vendor granted. \u201cWe approached Epic in the same way and sought their permission\u2014which they denied,\u201d he noted, adding that the vendor expressed concerns over intellectual property. \u201cWhile we\u2019re certainly respectful of their decision, we disagree with it. And, so, we have instead created a simulated EHR and mimicked the usability issues that we observed in Epic to show what was found in those products.\u201d

Epic did not provide a comment on the videos or the MedStar-AMA research. However, <\/b>Cerner acknowledged in a written statement that it volunteered to participate in the study, while making the case that the company is actively engaged in addressing physician burnout as an industry challenge.

\u201cWe\u2019re focused on engaging physicians in each step of the design of EHR workflows to better reflect how they deliver care,\u201d read Cerner\u2019s statement. \u201cThrough the use of analytics, research and feedback we are able to continuously optimize solutions to deliver a more personalized and intuitive care delivery experience.\u201d

For its part, the Office of the National Coordinator for Health IT provided a written statement emphasizing that the agency appreciates the efforts of MedStar and the AMA on this issue.

\u201cIf designed and implemented appropriately, health IT can improve overall patient safety,\u201d said the ONC spokesperson. \u201cWe also recognize that there are examples of health IT-related adverse events and the importance of reporting these events. Many of those are intercepted by clinicians before patients are impacted.\u201d

\u201cAs the report says, the 21st Century Cures Act directs HHS to report on patient safety organization activities that address health IT safety and directs ONC to improve the interoperability of health information,\u201d added the agency\u2019s spokesperson. \u201cAnd, as the report notes, part of that includes addressing what is known as \u2018information blocking\u2019\u2014which may include efforts by EHR developers to deny the sharing of information about their EHRs, including potential adverse events.\u201d","saveContent":"The largest healthcare provider in the Baltimore-Washington metropolitan area is urging Congress to take action when it comes to the link between electronic health record usability and patient safety.

MedStar Health has drafted a letter<\/a> to Senate and House committees calling on lawmakers to \u201caddress safety-related usability challenges\u201d and to implement a key provision of the 21st Century Cures Act.

While Congress has taken steps to address this problem, MedStar\u2019s letter contends that \u201csuccess depends upon effective implementation by the Office of the National Coordinator for Health Information Technology\u201d of Section 4002 of the Cures Act, which directs the \u201ccreation of an EHR Reporting Program, where ONC would collect and disseminate data on core EHR features, including usability.\u201d

\u201cIf developed effectively, this program can give providers, patients, the public and even EHR vendors better information on how these systems operate to address any challenges\u2014including usability and safety,\u201d the MedStar letter adds.

The not-for-profit health system, which operates 10 hospitals in the Baltimore-Washington region, is asking healthcare stakeholders to sign the letter to Congress by February 28 to lend support to the initiative.

\u201cPoor EHR usability promotes certain types of medical errors as physicians, nurses, and other clinicians use these systems to care for patients, and there is increasing evidence showing the association between usability issues and safety,\u201d states the letter.

Also See<\/b>: EHR usability issues pose safety risk to pediatric patients<\/a>

The American Medical Informatics Association issued a statement supporting the effort and urged other industry stakeholders to sign the letter to Congress.

\u201cWe have a fractured and loosely connected system to understand when health IT negatively impacts patient care, how such harms could have been avoided, and what changes to usability, design and implementation are necessary to mitigate such shortcomings in the future,\u201d said Doug Fridsma, MD, AMIA\u2019s president and CEO. \u201cThis inability to understand how health IT impacts safety across settings of care is why AMIA supports the establishment of a national public\/private center, or collaborative, on health IT safety meant to convene, analyze and disseminate information to improve the safety and safe use of health IT.\u201d

Raj Ratwani, director of the MedStar Health National Center for Human Factors in Healthcare, which authored the letter to Congress, contends that a central reporting system is needed \u201cso that clinicians, patients, and any other stakeholder that sees an EHR usability and safety issue can report it into that database.\u201d

On Monday, a viewpoint article<\/a> co-authored by Ratwani was published in JAMA calling for the creation of a national reporting system much like the Food and Drug Administration\u2019s Manufacturer and User Facility Device Experience database for medical devices.

\u201cTo create such a reporting system, clinicians must be permitted to report and illustrate various types of usability issues, and resources must be allocated by the ONC, HIT vendors and healthcare organizations for appropriate investigation into root causes of these issues so they can be resolved,\u201d states the article. \u201cThe 21st Century Cures Act, passed with bipartisan support in 2016, may provide the legal authority and regulatory framework to establish this database through ONC, which should be accessible by the public and allow anyone to report issues.\u201d

According to Ratwani, this kind of data must be available for analysis but he charges that \u201cgag clauses\u201d in contracts between EHR vendors and provider organizations \u201chas prevented open discussion of these kinds of issues and challenges.\u201d

However, in a written statement, the Electronic Health Record Association pointed out that EHR developers have a longstanding commitment to patient safety.

\u201cThe principles of the 2016 EHR Developer Code of Conduct promote patient safety,\u201d according to the group. \u201cEHRA also actively monitors, contributes and is committed to engagement with federal agencies, PSOs, trade associations, professional societies, liability carriers, academics and other stakeholders to collaborate on efforts to promote a culture of safety in health IT and evolve a non-punitive national learning system.\u201d

Nonetheless, MedStar and the American Medical Association have made available for the first time videos from the clinician\u2019s point of view that the provider organizations say demonstrate the risks and challenges caused by poor EHR usability.

The videos are posted on a website, EHRSeeWhatWeMean.org<\/a>, based on recent MedStar research<\/a> in partnership with the AMA regarding the EHR <\/b>usability of the two major health IT vendors with the largest market share\u2014Cerner and Epic. In the study, emergency medicine physicians from four health systems\u2014two using Cerner and two using Epic\u2014were given common tasks to perform in standardized clinical scenarios <\/b>mimicking real patient cases.

\u201c<\/b>What we found was huge variability in the time and error rates while completing those tasks,\u201d said <\/b>MedStar\u2019s Ratwani. <\/b>\u201cWe presented that information in a journal publication in 2018, and now we\u2019re showing the video snippets of those usability challenges.\u201d

Ratwani added that MedStar asked permission from the Cerner sites to show the actual video, which the vendor granted. \u201cWe approached Epic in the same way and sought their permission\u2014which they denied,\u201d he noted, adding that the vendor expressed concerns over intellectual property. \u201cWhile we\u2019re certainly respectful of their decision, we disagree with it. And, so, we have instead created a simulated EHR and mimicked the usability issues that we observed in Epic to show what was found in those products.\u201d

Epic did not provide a comment on the videos or the MedStar-AMA research. However, <\/b>Cerner acknowledged in a written statement that it volunteered to participate in the study, while making the case that the company is actively engaged in addressing physician burnout as an industry challenge.

\u201cWe\u2019re focused on engaging physicians in each step of the design of EHR workflows to better reflect how they deliver care,\u201d read Cerner\u2019s statement. \u201cThrough the use of analytics, research and feedback we are able to continuously optimize solutions to deliver a more personalized and intuitive care delivery experience.\u201d

For its part, the Office of the National Coordinator for Health IT provided a written statement emphasizing that the agency appreciates the efforts of MedStar and the AMA on this issue.

\u201cIf designed and implemented appropriately, health IT can improve overall patient safety,\u201d said the ONC spokesperson. \u201cWe also recognize that there are examples of health IT-related adverse events and the importance of reporting these events. Many of those are intercepted by clinicians before patients are impacted.\u201d

\u201cAs the report says, the 21st Century Cures Act directs HHS to report on patient safety organization activities that address health IT safety and directs ONC to improve the interoperability of health information,\u201d added the agency\u2019s spokesperson. \u201cAnd, as the report notes, part of that includes addressing what is known as \u2018information blocking\u2019\u2014which may include efforts by EHR developers to deny the sharing of information about their EHRs, including potential adverse events.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

MedStar calls on lawmakers to make EHR usability a priority

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