Increasing EHR usability and improving patient safety

December 21, 2023 |  EHR, Patient Engagement, Patient Safety

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Despite the wide adoption and optimization of EHRs across the continuum of care, some healthcare leaders view EHR usability as a pain point. This is proven by a recent JAMA Study (Journal of the American Medical Association) that found a positive association between frontline user–rated EHR usability and EHR safety performance. 

This research showed that poor EHR user experience strongly correlates with EHR-related patient safety concerns, particularly in the areas of medication alerts related to drug-drug interactions, patient allergies, duplicate orders, and excessive dosing. 

As noted in the JAMA Study, to avoid safety performance issues, it is important to use EHRs that are easy to learn and operate. This gives clinicians the freedom and flexibility to complete tasks efficiently, making it more likely to catch medical errors that could harm patients. 

MEDITECH’s conflict checking recommendations can increase EHR usability and improve patient safety. Here are specific ways of leveraging Expanse Interaction Checking measures to increase patient safety. 

Therapeutic Duplication: Medication combinations overlap therapeutically with the same agent or same class

MEDITECH leverages First Databank’s (FDB) Duplicate Therapy Module, designed to evaluate medications according to Duplicate Therapy (DPT) classes. FDB creates and maintains this content, assigning an FDB Duplicate Allowance Factor for more precise duplicate therapy conflict checking. The Duplicate Allowance Factor specifies the maximum number of matches that can occur within a Duplicate Therapy class without creating a warning. Any combination that represents a duplication and exceeds the allowance is returned along with explanatory information.

Drug-Dose: Single/Daily: Specified dose of medication exceeds safe range for a single or daily dose

MEDITECH leverages FDB’s Dosage Range Check Module to identify drug-dose conflicts. FDB provides information for single or daily dose warnings. Single doses are given one time only. Daily dosing information exists for Maintenance, Single, and Loading type dose ranges and are classified into Low, High, and Maximum dose values.

Drug-Allergy: Medication, or medication class, against which a patient allergy has been documented

MEDITECH leverages FDB's Drug-Allergy Module for both Allergy and Adverse Drug Reaction conflict checking. An Adverse Drug Reaction is a MEDITECH convention and does not exist natively in the FDB Framework API. The functionality for Adverse Drug Reactions parallels that of Allergies, using the FDB Drug-Allergy Module, via the same data fields coded on the patient's allergy profile (differentiated by the Type field).

Drug-Route: Specific route of administration is inappropriate and potentially harmful

Route of administration data is provided as a part of FDB’s MedKnowledge drug content, and loaded into the Pharmacy (PHA) Route of Administration Dictionary. Medication-specific route information is populated within the PHA Drug Dictionary and the route selection available during order entry is restricted to the list defined on the drug. The Pharmacy Drug Building Guide and Field Maps can be used as a guide for appropriate drug build and mapping.

Drug-Drug: Medications in pair of orders result in known harmful interaction when used in combination

MEDITECH leverages FDB’s Drug-Drug Interaction Module to identify clinically significant drug interactions. This includes screening for formulary, over-the-counter (OTC), alternative therapies, and inactive ingredients. Drug interactions screening is flexible and is enabled based on the following severity levels Contraindicated, Severe, Moderate, and/or Undetermined.

Drug-Age: Medication contraindicated based on patient age

MEDITECH leverages FDB’s Geriatric and Pediatric Precaution Modules to identify drug-age conflicts. The Pediatric Precaution Module screens for medications contraindicated in patients under 18 years of age, while the Geriatric Precaution Module screens for medications contraindicated in patients over 65 years of age. For additional drug-age screening, MEDITECH leverages FDB’s Dosage Range Check Module to populate age-specific dose range information in the Dose Range Dictionary. 

Improving information access through technology is central to delivering quality care and supporting the needs of healthcare organizations. Be sure to take advantage of MEDITECH recommendations and resources that help our customers meet national patient safety measures. 

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Written by Nichole Sikora, Senior Manager, Organizational Development, MEDITECH

Nichole Sikora is the Senior Manager of the Patient Safety/Priority Event Management team at MEDITECH. She oversees MEDITECH’s management of Adverse Events, Priority Events, and patient safety initiatives. Nichole also leads the Customer EHR Patient Safety Advisory Board and MEDITECH EHR Patient Safety Review Board. Prior to this role, she was in Client Services management supporting the Pharmacy (PHA) application.