Implications of electronic health record downtime: an analysis of patient safety event reports

• Published in: Journal of the American Medical Informatics Association : JAMIA 2018-02, Vol.25 (2), p.187-191
• Main Authors: Larsen, Ethan, Fong, Allan, Wernz, Christian, Ratwani, Raj M
• Format: Article
• Language: English
• Subjects: Brief Communication; Electronic Health Records; Equipment Failure; Health Facilities; Humans; Medical Errors - statistics & numerical data; Patient Safety
• ISSN: 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocx057

Abstract Objective We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analyzing the narratives of patient safety event report data. Materials and Methods From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by downtime. We also examined whether downtime procedures were in place and followed. Results The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that downtime procedures either were not followed or were not in place. Only 27.6% of incidents (n = 21) indicated that downtime procedures were successfully executed. Discussion Patient safety report data offer a lens into EHR downtime–related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards. Conclusion EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement.