When this question is posed, how can medical records cause patient harm? First of all there is the user interface and every EHR/EMR has one as that’s how the information is viewed and entered, software 101. Now there’s nothing intentional here with vendors as hours, days, weeks and more are spent working with beta users to make it the best interface that can be developed and there maybe a few exceptions but most developers want their creations to be a success by all means, as otherwise nobody buys it.
However, in the last couple of years the effort of user interfaces has become a little cloudy in the fact that more of the “payer” information have crept up with some priorities in some screens of the program and thus with the focus on money perhaps some of the user interface items may have slipped down a notch but they are still there. Money rules all today and something has to give when there are incentives along with doctors and hospitals not having enough operating funds in so many areas. One item quoted here was the fact that one system had fonts that were too small, so again was that a problem for one or many individuals? There’s no perfect system by all means as long as “humans” are using them.
Speaking of a “good” user interface, there was this project from Microsoft a few years ago that was to incorporate and create a standard user interface that any medical record system could use, as it would make it easier for doctors who work at more than one hospital system to use instead of learning multiple user interfaces. I had one med student email me a while back and he said he learned 5 systems to get through his residency and I am guessing he included PACS systems in there as well.
EHRs need Standard Templates – So Let’s Look at the Common User Interface Project, a lot of the work is already in progress and partially completed
Ok so here’s the idea that was ahead of it’s time maybe? Now we have many vendors looking over their user interfaces for fixes…what if all those vendors looked at one interface or at one that was pretty closely emulated by all? Sounds like a lot easier job to me than looking at several hundred user interfaces. Of course there’s a few other areas to look at with ensuring correct calculations and warnings but most of those are not very prominent by comparison.
So, did we make an mistake in not giving a Common User Interface a little more attention with everyone building the “perfect” mouse trap? This was all started back in 2008 and granted things became a bit more complex since that time but software grows on itself with additional layers added all the time, so maybe an idea that for whatever reason was sidelined? I wrote this back in 2009 and being I wrote a simple EMR system years ago I kind of liked this idea as I looked at how much code and time is devoted to medical record system programming. It’s a lot and look at the Allscripts case if you need more proof on the time it takes to write code today to make things work for the end users. Granted the Silverlight portion could be updated to HTML5 to work in today’s world.
So in essence when it comes to innovation, we still don’t do very well with collaborating in some key areas it seems, right? A few years ago I asked that question of several doctors if they would like the idea of having the same or very similar interface at every hospital, and nobody said no:) So now this is what we are left with, hundreds of EHR/EMR systems with different user interfaces to look at and track down the small fonts, data display for users, etc. anywhere that the software could make it difficult for humans. I don’t’ know what this will end up netting in the long run but there’s no system that is 100% proof and again aside from looking at some of the payer priorities that may have entered to cloud some of this or making too much available on one screen with too many clicks..I’m not sure what this process is going to accomplish.
A year ago GE found it had some errors as their system update created issues with attesting that they had to fix and this is just the world of software and is not patient related but goes to show issues will arise everywhere and to classify what is harm and what is not may be a little intense. At this point I’m glad I’m not having to do this after the hours and part of a “life” that I put into programming and writing a system to find all of this or I would literally die at the keyboard:) BD
GE Centricity EHRs Need To Fix Their Algorithms (Math)-Some Customers May Not Be Able to Attest Until The End of November After the Software Update
The Obama administration Friday urged cooperation between software companies and caregivers to prevent patient harm caused by faulty electronic records. But it stopped short of calling for regulation or a federal requirement to report computer mistakes that pose a risk to patients.
“We are saying to the vendors: Step up and prove your ability to create a code of conduct that would be enforceable, that would bind you voluntarily to reporting safety events,” Dr. Farzad Mostashari, the administration’s coordinator for health information technology, said about the report. “And what we’re saying is: If you don’t step up, we can always look at more classic regulatory approaches.”