EHR-related Safety Events

Hospitals around the globe are fast implementing or are now expanding on the use of Electronic Health Records (EHRs). The notion is that hospitals are able to provide better quality of care and at the same time, ensure improved productivity for providers with computer equipment hosting the EHRs.

While we watch the whole world marching onwards in implementation and expansion of EHRs, readers are reminded of the aspects of patient safety as defined by the World Health Organisation, which is to prevent errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff, and the public are likely to expect when they are at hospitals. Thus the safety net must not only safeguard patients but staff caring for the patients and visitors to hospitals. As such, safety controls from hazards or risks posed by buildings, grounds, and equipment (JCI 2013) such as computers and EHRs to patients, families, staff, and the public must be in place at hospitals to prevent safety related events.

In this post I have summarised graphically into three (3) charts contributing factors for EHR-related Safety Events and on how to prevent, mitigate, and react to them. The facts presented in the charts are based on the opinions given by three (3) Joint Commission Resources (JCR) and JCI consultants on the ever-increasing EHR lawsuits in the United States between 2013 and 2014, as was reported recently in Becker’s Health IT and CIO Review.

The Charts 1 and 2 show eight (8) common causes of EHR-related safety events as follows:

  1. user error
  2. EHR builds
  3. workflows
  4. limited EHR interoperability across all three levels of health information technology interoperability i.e. foundational, structural and semantic levels
  5. deficient provider EHR education
  6. poor post-deployment vendor or institutional support
  7. losing sight of EHR best practices
  8. organisations that do not have a well-organised paper medical record cannot describe what they want in an EHR thus leading to work arounds 


EHR-related-Safety-Events-2Chart 3 presents six (6) ideas on what can be done to decrease the number of EHR-related safety mistakes which are:

  1. need to make end users aware of the potential this technology has to contribute to safety events
  2. encourage the reporting of events that may be related to EHRs
  3. if an EHR-related safety event occurs, the event should be analysed
  4. resources should be available to address post go-live optimization
  5. third party consultants
  6. use patient safety and standards and processes as the structure for appraisal and guidance

EHR-related-Safety-Events-3As we in this part of the world are implementing quality standards from the JCI, appraisal and guidance to focus on and prevent EHR-related Safety Events can be found in the Leadership chapter and the Management of Information chapter found in Joint Commission International Standards for Hospitals, as recommended by these three (3) Consultants.

I like to conclude that while hospitals worldwide are riding the wave of implementing or now expanding on the use of EHRs, it is best to be aware of whatever the contributing factors to EHR-related Safety Events maybe including those identified in this post, and to be accountable to prevent or minimise such events with awareness and the necessary knowledge as outlined by the above mentioned Consultants.


  1. Healthcare Information and Management Systems Society(HIMSS) 2015, What is Interoperability?, viewed 18 June 2015, <>
  2. HealthITInteroperability 2015, HealthITInteroperability Definitions, viewed 18 June 2015, <>
  3. James,  S., The Book on Healthcare IT: Volume 2, 2015
  4. Joint Commission International 2015, JCR and JCI Consultants on Reducing and Preventing EHR-related Safety Events, viewed 18 June 2015, <>
  5. Joint Commission International 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA
  6. Margret, A., Process Improvement with Electronic Health Records A Stepwise Approach to Workflow and Process Management, 2012, CRC Press, Florida, United States of America
  7. World Health Organisation 2015, Patient safety, viewed 18 June 2015, <>

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