Efficiency and Safety of Electronic Health Records in Switzerland—A Comparative Analysis of 2 Commercial Systems in Hospitals

Abstract

ObjectivesDifferences in efficiency and safety between 2 electronic health record (systems A and B) in Swiss hospitals were investigated.MethodsIn a scenario-based usability test under experimental conditions, a total of 100 physicians at 4 hospitals were asked to complete typical routine tasks, like medication or imaging orders. Differences in number of mouse clicks and time-on-task as indicators of efficiency and error type, error count, and rate as indicators of patient safety between hospital sites were analyzed. Time-on-task and clicks were correlated with error count.ResultsThere were differences in efficiency and safety between hospitals. Overall, physicians working with system B required less clicks (A: 511, B: 442, P = 0.001) and time (A: 2055 seconds, B: 1713 seconds, P = 0.055) and made fewer errors (A: 40%, B: 27%, P < 0.001). No participant completed all tasks correctly. The most frequent error in medication and radiology ordering was a wrong dose and a wrong level, respectively. Time errors were particularly prevalent in laboratory orders. Higher error counts coincided with longer time-on-task (r = 0.50, P < 0.001) and more clicks (r = 0.47, P < 0.001).ConclusionsThe variations in clicks, time, and errors are likely due to naive functionality and design of the systems and differences in their implementation. The high error rates coincide with inefficiency and jeopardize patient safety and produce economic costs and burden on physicians. The results raise usability concerns with potential for severe patient harm. A deeper understanding of differences as well as regulative guidelines and policy making are needed.

Impact of a clinical decision support system on paediatric drug dose prescribing: a randomised within-subject simulation trial

“…On the other hand, a good integration will simply rule out even more types of errors by design (eg, transcription errors). Interestingly, clinical information system providers do not need to conduct usability tests as compared with European medical device manufacturers 29 30. Last but not least, we think that it is undisputable that we should prevent the occurrence of an error in the first place by using a dose calculator rather than to rely on post hoc measures or on the commendable vigilance of the HCPs 10 11 28…”

Electronic Health Record Usability Contributions to Patient Safety and Clinician Burnout: A Path Forward

“…The number of clicks to order a medication ranged from 14 to 61. In Europe, Fischer and Schwappach 10 used a similar design adapted to internal medicine in four Swiss hospitals, using EHR products from 2 different vendors. They report that none of the 100 participating clinicians could complete all tasks without error.…”