EHR usability issues may contribute to potential patient harm

JAMA letter notes challenges in medication administration

Challenges to usability in electronic health records (EHRs) may contribute to potential harm to patients, say researchers in a letter to JAMA published online March 27. In the study, researchers at MedStar Health’s National Center for Human Factors reviewed patient safety reports—free-text descriptions of safety events voluntarily entered by health care staff—retrieved from the Pennsylvania Patient Safety Authority database. They found that out of 1.735 million reported safety events from 2013 through 2016, 1,956 that were reported as possible patient harm mentioned an EHR vendor or product.

Furthermore, 557 reports explicitly suggested that EHR usability contributed to possible patient harm.

The researchers noted which processes were affected by EHR usability problems, with medication administration (37%) second only to order placement (38%). The remaining processes affected were review of results (16%) and documentation (9%).

The researchers categorized the overall challenges with EHR usability into the following seven categories:


  • data entry (27%)
  • alerting (22%)
  • interoperability (18%)
  • visual display (9%)
  • availability of information (9%)
  • system automation and defaults (8%)
  • workflow support (7%)

Alerting was the most frequently cited usability category for potential harm events related to medication administration specifically.

In their discussion of the research, the authors noted that although only a small percentage of potential harm events were associated with EHR usability compared with the 1.735 million safety events reported overall for the study period, their analysis was conservative partly because reports capture only a small fraction of the actual number of safety events.