The Agency for Healthcare Research and Quality’s (AHRQ) Digital Healthcare Research Program https://digital.ahrq.gov invests in applied digital healthcare research to help clinicians understand what to do to make patient care safer.
However, the healthcare industry reports that although EHRs have improved the coordination and quality of patient care, it has been reported that poor EHR design, usability, and implementation, has also led to unintended consequences that may have resulted in adverse events or other medical errors harming patients.
Although the majority of potential errors are either caught by safety checks built into EHRs or are identified by staff, there is no system in place to retrospectively identify and review potential errors where the information could be used to make improvements in EHR design and usability.
Dr. Aaron (Zach) Hettinger and a research team at the MedStar National Center for Human Factors in Healthcare https://medicalhumanfactors.net received funding from AHRQ for $297,840 to find a way to identify near misses in healthcare. They looked to another high risk industry which is the airline’s use of a black box that captures actions leading up to a near miss or error.
The aviation’s black box is able to examine why and what types of errors occurred, and then put in systems to capture the context around errors. The question is Can the concept of a black box be applied to healthcare to improve EHR systems and patient safety?
By applying an innovative health IT black box methodology, a video screen is able to capture clinical interaction in the EHR including mouse movement and keystrokes. The errors were retrospectively analyzed to understand the factors that led to those errors. This approach successfully identified and allowed a review of multiple EHR-based errors, while providing recommendations and guidance for the researchers to use when designing the EHR.
Dr. Hettinger and his team showed the feasibility and value of creating a methodology and process for the health IT Black box to inform EHR design and usability. Seeing the EHR through the eyes of the clinician, at the exact moment that an error occurs is a powerful tool for change. The value of this tool is amplified when the same error is demonstrated across institutions, providers, and settings that use a common EHR.
The researchers are confident by studying errors across systems, implementing active surveillance, like the health IT black box, will enable designing systems that facilitate easier and safer care for patients.