MedStar Human Factors Center Launches and Encourages Action

On Feb. 4, 2019, the MedStar Health National Center for Human Factors in Healthcare launched and a related campaign, presenting compelling evidence for the need to address the known risks to patient safety and clinician burnout that stem from poor electronic health record (EHR) usability—and calling for action.

The website, which was launched in collaboration with the American Medical Association, makes videos from the clinician’s point of view available for the first time to demonstrate the risks and challenges caused by poor EHR usability, which is the extent to which the technology can be used efficiently, effectively, and satisfactorily. The site also specifically calls out what multiple stakeholders—policymakers, healthcare providers, EHR vendors, and patients—can do.

The theme of the website and campaign is ‘Everybody Has Responsibilities’ to stress the need for increased collaboration. As a shared opportunity for action, stakeholders can sign the MedStar Human Factors Center’s letter to elected leaders of the United States Senate and House committees that can prioritize EHR usability and safety in their oversight of new policies being put in place by the Department of Health and Human Services. Click here to sign the letter to Congress by Feb. 28, 2019, the month that marks the 10-year anniversary of the federal act that successfully promoted the widespread adoption of EHRs.

For a deep dive into the research and thought leadership informing that letter, read the Journal of the American Medical Association Viewpoint, “A Decade of Health Information Technology Usability Challenges and the Path Forward,” which was written by Raj Ratwani, PhD, who leads MedStar’s Human Factors Center, and two co-authors, all of whom serve as top EHR usability and safety experts.

Learn more about the videos and campaign in MedStar’s press release: “Experts Call for Safety Improvements as Widespread EHR Adoption Reaches 10 Year Milestone.”

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Marianne Worley
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Journal of the American Medical Association: Improving Electronic Health Record Usability and Safety Requires Transparency


On Nov. 29, 2018, the Journal of the American Medical Association published a viewpoint article titled, “Improving Electronic Health Record Usability and Safety Requires Transparency,” by authors from MedStar Health’s National Center for Human Factors in Healthcare, American Medical Association, and Brigham and Women’s Hospital.

The opinion piece examines how gag clauses in EHR vendor and healthcare provider contracts block providers from openly addressing EHR usability and safety issues, representing “a market failure.” Despite the 21st Century Cures Act inviting action to help prevent this in 2016, the Office of the National Coordinator (ONC) of Health Information Technology has yet to define what constitutes blocking EHR usability and safety information. The article discusses three main criteria the ONC should consider in doing so and why it’s critical to act on this now.

Learn more about the background and policy recommendations tied to this issue in MedStar’s related press release: “3 Policy Changes That Could Make Electronic Health Record Systems Safer and Easier to Use.”

Photo Credit: Health Affairs.

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Marianne Worley 
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Health Affairs: Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings


On Nov. 5, 2018, the health policy journal Health Affairs published an article by MedStar Health’s National Center for Human Factors in Healthcare and its collaborators titled, “Identifying Electronic Health Record Usability and Safety Challenges in Pediatric Settings.”

It reported that electronic health records (EHRs) may present a significant risk to the health and safety of children. Of 9,000 analyzed pediatric reports more than one third described a medication error that was related to EHR usability. The findings emerged from the analysis of pediatric patient safety event reports that were likely to be related to EHRs and medication, gathered from three healthcare systems.

Learn more about the findings, related stakeholders, and calls to action in MedStar’s press release: “Additional Safety Measures Recommended After Study Finds EHR Usability Issues Pose Risk to Children.”

Raj Ratwani, PhD, director of MedStar’s Human Factors Center and a lead researcher and author, also discussed the study further on Nov. 6 as part of a Health Affairs briefing on its full “Patient Safety” issue, where numerous article authors commented on the best and latest research on this topic. Click here to read more and watch the recorded webcast.

Photo credit: Health Affairs.

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Marianne Worley
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5 Recommendations to Make EHRs Safer for Pediatric Patients

MedStar Health and Pew Charitable Trusts Respond to Congressional Act

September 10, 2018

Washington, D.C. (September 10, 2018)—Experts with MedStar Health’s National Center for Human Factors in Healthcare have leveraged their past research into the safety and usability of electronic health records (EHRs) to join with The Pew Charitable Trusts in offering recommendations to the federal government for making the health IT systems safer for children, whose unique needs make them particularly vulnerable to documented EHR usability and patient safety issues. The recommendations were published today by the American Medical Association in its journal JAMA Pediatrics, in a Viewpoint article entitled “Improving Pediatric Electronic Health Record Usability and Safety through Certification.”

The authors are Raj M. Ratwani, PhD, with National Center for Human Factors in Healthcare, and Ben Moscovitch, MA, and Josh P. Rising, MD, with The Pew Charitable Trusts.

Their recommendations are in response to a provision in the 21st Century Cures Act, passed by Congress in 2016, for the Office of the National Coordinator to develop a voluntary program that would certify EHRs in a way that accounts for unique issues in pediatric care.

“Children have unique healthcare needs, and oftentimes care processes that may work well for adults do not work for children,” says Dr. Ratwani. “While we have recognized the unique needs of children when it comes to things like medications, we have not recognized this need when it comes to technology like the electronic health record.” EHRs, which are almost universally used across the United States to manage patient care, are not tailored to the unique needs of children or clinicians who treat them, and this can put pediatric patients at risk.

The authors cite a couple of instances where the poor usability of EHRs has contributed to potential harm:

  • Medication dosages for children are based on weight, and poor EHR usability has contributed to overdoses being given when a confusing EHR display makes it difficult to enter a child’s correct weight.
  • Age-appropriate vaccinations may be overlooked due to the EHR’s failure to notify the clinician of a needed vaccine or the wrong vaccination may be given when the EHR recommends a vaccine that is inappropriate given the child’s age.

The authors provide these five recommendations for a certification program:

  • Require EHR vendors to provide evidence that they are employing a user-centered design process.
  • Require that usability test participants represent the clinical end users.
  • Define and require the use of rigorous test cases to assess usability and safety.
  • Recognize that EHR implementation is crucial to safety, and consider the entire EHR life-cycle—not just the development phase—when granting certification.
  • Encourage transparency in sharing usability and safety challenges to improve safety and EHR product.


About the National Center for Human Factors in Healthcare

The National Center for Human Factors in Healthcare occupies a unique position in the United States as the largest human factors program embedded within a healthcare system. It brings together human factors scientists, systems safety engineers, health services researchers, and clinicians to conduct safety science and applied research in medicine to improve safety, quality, efficiency, and reliability. The center is part of the MedStar Institute for Innovation and is affiliated also with the MedStar Health Research Institute. MedStar Health, the parent organization, is the largest not-for-profit healthcare provider in the Maryland and Washington, D.C., region, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.

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Marianne Worley
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Texas A&M School of Public Health: Miller Awarded 1.4 million to Develop Sepsis Alert System

Kristen Miller
Kristen Miller, DrPH, CPPS

Kristen Miller, DrPH, CPPS, Senior Research Scientist at the National Center for Human Factors in Healthcare at MedStar Health, was featured in a Texas A&M School of Public Health Spring 2017 alumni spotlight. She was recognized for being awarded a 4-year, $1.4 million R01 research grant from the U.S. National Library of Medicine through the U.S. National Institutes of Health to develop a new approach to detect and treat sepsis—which nationally infects about 1 million people annually, killing a quarter of them.

Miller will lead this work from MedStar, marking a significant milestone for the MedStar Institute for Innovation (MI2) and its National Center for Human Factors in Healthcare, as the NIH R01 research grant is among the most prestigious awards. This is the third R01 grant awarded to an MI2 associate.

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