Skip to Main Content
HBS Home
  • About
  • Academic Programs
  • Alumni
  • Faculty & Research
  • Baker Library
  • Giving
  • Harvard Business Review
  • Initiatives
  • News
  • Recruit
  • Map / Directions
Faculty & Research
  • Faculty
  • Research
  • Featured Topics
  • Academic Units
  • …→
  • Harvard Business School→
  • Faculty & Research→
Publications
Publications
  • Article
  • JAMA Network Open

National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018

By: David Classen, A Jay Holmgren, Zoe Co, Lisa Newmark, Diane Seger, Melissa Danforth and David Bates
  • Format:Electronic
ShareBar

Abstract

Importance Despite the broad adoption of electronic health record (EHR) systems across the continuum of care, safety problems persist. Objective To measure the safety performance of operational EHRs in hospitals across the country during a 10-year period. Design, Setting, and Participants This case series included all US adult hospitals nationwide that used the National Quality Forum Health IT Safety Measure EHR computerized physician order entry safety test administered by the Leapfrog Group between 2009 and 2018. Data were analyzed from July 1, 2018 to December 1, 2019. Exposure The Health IT Safety Measure test, which uses simulated medication orders that have either injured or killed patients previously to evaluate how well hospital EHRs could identify medication errors with potential for patient harm. Main Outcomes and Measures Descriptive statistics for performance on the assessment test over time were calculated at the overall test score level, type of decision support category level, and EHR vendor level. Results Among 8657 hospital-years observed during the study, mean (SD) scores on the overall test increased from 53.9% (18.3%) in 2009 to 65.6% (15.4%) in 2018. Mean (SD) hospital score for the categories representing basic clinical decision support increased from 69.8% (20.8%) in 2009 to 85.6% (14.9%) in 2018. For the categories representing advanced clinical decision support, the mean (SD) score increased from 29.6% (22.4%) in 2009 to 46.1% (21.6%) in 2018. There was considerable variation in test performance by EHR. Conclusions and Relevance These findings suggest that despite broad adoption and optimization of EHR systems in hospitals, wide variation in the safety performance of operational EHR systems remains across a large sample of hospitals and EHR vendors. Hospitals using some EHR vendors had significantly higher test scores. Overall, substantial safety risk persists in current hospital EHR systems.

Keywords

Electronic Health Record Systems; Health Care and Treatment; Information Technology; Performance; Safety; Measurement and Metrics; United States

Citation

Classen, David, A Jay Holmgren, Zoe Co, Lisa Newmark, Diane Seger, Melissa Danforth, and David Bates. "National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018." JAMA Network Open 3, no. 5 (May 2020).
  • Read Now

More from the Authors

    • March 2022
    • Journal of the American Medical Informatics Association

    Assessing the Impact of the COVID-19 Pandemic on Clinician Ambulatory Electronic Health Record Use

    By: A Jay Holmgren, Lance Downing, Mitchell Tang, Christopher Sharp, Christopher Longhurst and Robert S. Huckman
    • February 2021
    • JAMA Internal Medicine

    Assessment of Electronic Health Record Use Between U.S. and Non-U.S. Health Systems

    By: A Jay Holmgren, Lance Downing, David W. Bates, Tait D. Shanafelt, Arnold Milstein, Christopher Sharp, David Cutler, Robert S. Huckman and Kevin A. Schulman
    • November 2020
    • Journal of the American Medical Informatics Association

    Barriers to Hospital Electronic Public Health Reporting and Implications for the COVID-19 Pandemic

    By: A Jay Holmgren, Nate Apathy and Julia Adler-Milstein
More from the Authors
  • Assessing the Impact of the COVID-19 Pandemic on Clinician Ambulatory Electronic Health Record Use By: A Jay Holmgren, Lance Downing, Mitchell Tang, Christopher Sharp, Christopher Longhurst and Robert S. Huckman
  • Assessment of Electronic Health Record Use Between U.S. and Non-U.S. Health Systems By: A Jay Holmgren, Lance Downing, David W. Bates, Tait D. Shanafelt, Arnold Milstein, Christopher Sharp, David Cutler, Robert S. Huckman and Kevin A. Schulman
  • Barriers to Hospital Electronic Public Health Reporting and Implications for the COVID-19 Pandemic By: A Jay Holmgren, Nate Apathy and Julia Adler-Milstein
ǁ
Campus Map
Harvard Business School
Soldiers Field
Boston, MA 02163
→Map & Directions
→More Contact Information
  • Make a Gift
  • Site Map
  • Jobs
  • Harvard University
  • Trademarks
  • Policies
  • Accessibility
  • Digital Accessibility
Copyright © President & Fellows of Harvard College