Menon Shailaja, Singh Hardeep, Giardina Traber D, Rayburn William L, Davis Brenda P, Russo Elise M, Sittig Dean F
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Baylor Scott and White, College Station, TX, USA.
J Am Med Inform Assoc. 2017 Mar 1;24(2):261-267. doi: 10.1093/jamia/ocw153.
Methods to identify and study safety risks of electronic health records (EHRs) are underdeveloped and largely depend on limited end-user reports. "Safety huddles" have been found useful in creating a sense of collective situational awareness that increases an organization's capacity to respond to safety concerns. We explored the use of safety huddles for identifying and learning about EHR-related safety concerns.
Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. Huddles were attended by key administrative, clinical, and information technology staff. We conducted a content analysis of huddle notes to identify what EHR-related safety concerns were discussed. We expanded a previously developed EHR-related error taxonomy to categorize types of EHR-related safety concerns recorded in the notes.
On review of daily huddle notes spanning 249 days, we identified 245 EHR-related safety concerns. For our analysis, we defined EHR technology to include a specific EHR functionality, an entire clinical software application, or the hardware system. Most concerns (41.6%) involved " EHR technology working incorrectly, " followed by 25.7% involving " EHR technology not working at all. " Concerns related to "EHR technology missing or absent" accounted for 16.7%, whereas 15.9% were linked to " user errors ."
Safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns. Based on our findings, we recommend that health care organizations consider huddles as a strategy to promote understanding and improvement of EHR safety.
识别和研究电子健康记录（EHR）安全风险的方法尚不完善，且很大程度上依赖于有限的终端用户报告。已发现“安全碰头会”有助于营造集体态势感知氛围，增强组织应对安全问题的能力。我们探讨了利用安全碰头会来识别和了解与EHR相关的安全问题。
数据取自美国一家中型三级护理医院在1年多时间里记录的每日安全碰头会简报笔记。关键行政、临床和信息技术人员参加了碰头会。我们对碰头会笔记进行了内容分析，以确定讨论了哪些与EHR相关的安全问题。我们扩展了先前开发的与EHR相关的错误分类法，对笔记中记录的与EHR相关的安全问题类型进行分类。
在审查了涵盖249天的每日碰头会笔记后，我们识别出245个与EHR相关的安全问题。为了进行分析，我们将EHR技术定义为包括特定的EHR功能、整个临床软件应用程序或硬件系统。大多数问题（41.6%）涉及“EHR技术运行错误”，其次是25.7%涉及“EHR技术完全无法运行”。与“EHR技术缺失或不存在”相关的问题占16.7%，而15.9%与“用户错误”有关。
安全碰头会促进了组织层面与技术相关的若干问题的讨论，可作为识别和解决与EHR相关安全问题的一种有前景的技术。根据我们的研究结果，我们建议医疗保健组织将碰头会视为促进对EHR安全的理解和改进的一种策略。
