Improving Electronic Health Record Usability for Patient Safety


Optimizing Care Delivery for Clinicians


Improving Healthcare Technology Design to Advance Patient Safety

Analysis of patient safety event reports showed an association between electronic health record (EHR) usability and patient safety in both adults and children and led to development of an EHR assessment tool that healthcare facilities can use to identify usability and safety issues.

Poor EHR design and usability hurts patients and burns out providers

While EHRs are used almost universally by hospitals and healthcare facilities across the country, these systems are not usually deliberately designed, developed, and implemented with a focus on usability. Poor design and usability can lead to errors that compromise patient safety and disrupt provider workflow, contributing to increased cognitive burden. Such challenges can lead to provider burnout, resulting in providers leaving the profession. To better understand EHR usability and safety issues, Dr. Raj Ratwani and a team of researchers at MedStar Health’s National Center for Human Factors in Healthcare partnered with computer scientists and clinical experts at Georgetown University and the Institute for Safe Medication Practices to pinpoint digital healthcare-related patient safety gaps in current EHR systems.

Identifying EHR usability issues and potential harm to patients

The research team developed algorithms to identify usability and safety issues from patient safety event reports. Explicit language was identified to associate possible patient harm with an EHR usability issue, in both adults and children. The analysis allowed the team to systematically categorize the EHR-related patient safety events as usability design- or implementation-related issues, and identify the specific user-centered design or implementation process that would have prevented the patient safety event.

“One of the really seminal things that came out of this work is that for the first time, we showed the connection between electronic health record usability and patient safety issues, essentially that patients can be harmed because of the way some of these systems are designed and being used.”
- Dr. Raj Ratwani

Improving EHR usability and safety for any organization

Based on these results, an EHR usability and safety evaluation tool was developed and successfully tested at two healthcare facilities. This tool can be used by any healthcare facility to identify specific issues in its EHR and to identify potential solutions to those issues through usability improvements. The tool includes a guide for how to perform the assessment so that it can be self-administered and disseminated broadly.