Cahill Marie, Cleary Brian J, Cullinan Shane
School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland (RCSI), 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland.
Department of Pharmacy, The Rotunda Hospital, Dublin 1, Ireland.
BMC Health Serv Res. 2025 Jan 6;25(1):31. doi: 10.1186/s12913-024-12060-2.
The advantages of electronic health records (EHRs) are well-documented regarding the process of care, enhanced data accessibility and cost savings. However, EHR design can also contribute to usability challenges, with poorly designed EHRs being implicated in user errors including patient overdoses. Our study seeks to evaluate how EHR design influences both usability and medication safety.
A systematic review was conducted of PubMed, EMBASE, CINAHL and the ACM library from 1 January 2009 to 8 October 2024. Eligible studies reported on the impact of specific EHR design elements on usability and/or medication safety, involved healthcare providers and took place in a secondary, tertiary or quaternary care setting. Usability was defined as the extent to which an EHR can be used to achieve specified goals with effectiveness, efficiency and satisfaction, while medication safety related to the risk of drug-related problems, including adverse drug events and medication errors. Design features identified within studies were validated, by cross-referencing these elements with ISO standards regarding design recommendations. A narrative synthesis was conducted, with studies tabulated based on whether they assessed usability and/or medication safety. Patterns were identified and common design elements between studies translated into themes. The Mixed Methods Appraisal Tool was used to evaluate study quality and PRISMA guidelines were followed throughout.
Thirty-two studies were identified. The design features described in these studies fit within seven broad design themes: searchability, automation, customisation, data entry, workflow, user guidance and interoperability. EHR systems that prioritised these areas were associated with higher reported usability and enhanced medication safety, while the opposite was found for systems that overlooked these design aspects. Our review also highlighted the numerous ways these themes can be implemented, while identifying the contributing factors that enable their successful implementation.
The design of EHRs can enhance or undermine usability and medication safety, depending on the searchability and customisability of these systems, how data entry processes and provider workflow are facilitated and how automation, user guidance and interoperability are implemented. Future EHR evaluations should be performed throughout the design process and consensus building is required regarding what exactly constitutes a design element, within an EHR context.
电子健康记录（EHRs）在护理过程、增强数据可及性和节省成本方面的优势已有充分记录。然而，EHR的设计也可能导致可用性方面的挑战，设计不佳的EHR与包括患者用药过量在内的用户错误有关。我们的研究旨在评估EHR设计如何影响可用性和用药安全。
对2009年1月1日至2024年10月8日期间的PubMed、EMBASE、CINAHL和ACM图书馆进行了系统综述。符合条件的研究报告了特定EHR设计元素对可用性和/或用药安全的影响，涉及医疗保健提供者，并在二级、三级或四级护理环境中进行。可用性被定义为EHR能够在有效性、效率和满意度方面用于实现特定目标的程度，而用药安全与药物相关问题的风险有关，包括药物不良事件和用药错误。通过将这些元素与关于设计建议的ISO标准进行交叉引用，对研究中确定的设计特征进行了验证。进行了叙述性综合分析，根据研究是否评估了可用性和/或用药安全对研究进行列表。识别出模式，并将研究之间的共同设计元素转化为主题。使用混合方法评估工具评估研究质量，并始终遵循PRISMA指南。
确定了32项研究。这些研究中描述的设计特征可归纳为七个广泛的设计主题：可搜索性、自动化、定制、数据录入、工作流程、用户指导和互操作性。优先考虑这些领域的EHR系统与报告的更高可用性和增强的用药安全相关，而忽视这些设计方面的系统则相反。我们的综述还强调了这些主题可以实施的多种方式，同时确定了促成其成功实施的因素。
EHR的设计可以增强或破坏可用性和用药安全，这取决于这些系统的可搜索性和可定制性、数据录入流程和提供者工作流程的便利程度以及自动化、用户指导和互操作性的实施方式。未来的EHR评估应在整个设计过程中进行，并且需要就EHR背景下究竟什么构成设计元素达成共识。
