Ensuring Safe Performance of Electronic Health Records

While electronic health records (EHRs) have universally been adopted in healthcare settings in the United States, patient safety in the inpatient setting is still a critical issue. Although patient safety and quality of care are the highest priority in EHR implementation, hospitals have flexibility in system configuration, including the type of medication-related decision support implemented. Therefore, it is critical that hospitals routinely assess their EHR’s ability to avoid medication errors. The research team developed the Leapfrog Computerized Provider Order Entry (CPOE) Evaluation tool, which evaluates the medication safety of EHRs. This testing system is a “flight simulation,” which allows hospitals to evaluate their EHR's ability to address high-impact EHR-related and -impacted safety issues.

The specific aims of this research were as follows:

• Measure the national progress on test performance by hospitals in inpatient EHRs in key domains, both in a cohort of hospitals which has taken the test serially, and then in hospitals overall. 
• Work to ensure that inpatient EHRs improve safety by updating a widely used existing test. 
• Improve the test in four test sites to cover additional new high-impact safety clinical domains and iteratively refine them in four health systems, representing four leading EHR vendors. 

The Leapfrog CPOE Evaluation Tool is a timed, online assessment that simulates prescriber scenarios that can be fatal to patients, and records whether critical decision support appears in response to predefined groups of orders. Hospitals receive immediate feedback on their performance that can help inform improvements in their EHR decision support systems. For the current study, the research team updated the existing software platform with content updates for care guidelines, as well as designed new testing areas.

Participating hospitals represented all four regions of the Unites States, with the majority having 100-399 beds and in urban areas. The team collected and analyzed test results, demographic information, and responses to every medication order. The research team found that overall hospital performance improved from 2014 to 2018. However, while hospitals generally excelled in areas concerning basic decision support, shortcomings in advanced decision support were identified. In addition, the research team created three new modules, one of which was piloted in three hospitals to test systems on their ability to help providers avoid ordering unnecessary tests and procedures. Although there was overall improvement in hospitals' performance in using the tool, the team noted that there are still areas for improvement, demonstrating the importance of ongoing testing of EHRs to identify patient safety problems.