Improving Patient Safety and Clinician Cognitive Support Through eMAR Redesign

While new medication assistive technologies, such as computerized provider order entry, electronic medication administration records (eMAR), and barcode medication administration have been developed to support the medication process they continue to be both usability and safety issues. These issues have led to new patient safety threats as well as workforce frustration and burden which also impacts patient safety. Addressing these usability and safety issues requires a deeper understanding of the specific design issues that are contributing to patient safety threats, an analysis of how clinicians currently use these technologies, and the ideal workflows and information displays to appropriately support clinical use, as well as specific recommendations for improvements.

Therefore, this research sought to understand how digital healthcare technology is used to support the medication process in inpatient settings at two large healthcare systems and how the usability of these technologies can impact patient safety and provider burden.

The specific aims of the research were as follows:

• Identify health information technology usability issues during the medication process that contribute to patient safety.
• Analyze these issues to identify specific usability aspects that should be addressed.
• Determine what usability measures and specific usability issues are identified in the literature and whether they are aligned with our findings.

The study team used several different methods for the research including qualitative analysis of patient safety event reports, interviews with clinicians, and usability testing methods.

The analysis of patient safety event reports revealed that most technology-related issues associated with medication errors occur most commonly during the ordering and reviewing of medications and are due to usability; nearly half of these issues reach the patient. The interviews identified several specific usability issues that were aligned with those found during the analysis of patient safety event reports. These included issues with visual display, alerting, and workflow. The scoping review also aligned with the interviews and safety reports. A systematic review of usability measures found that most measures were qualitative in nature and that most measurement was focused on effectiveness and satisfaction rather than efficiency.

The researchers highlight several significant aspects of this research. First, the research underscores the criticality of usability of technology in the medication process with most safety issues related to usability. Second, there are clear common usability issues that emerged from the analysis of patient safety reports, the interviews, and the scoping review. Third, the scoping review pinpoints immediate changes that should be made to these technologies, and the broader work system to address the identified usability and patient safety issues.