Electronic patient record systems: recurring themes arising from safety investigations (HSSIB, 19 December 2023)

Summary

The Health Services Safety Investigations Body (HSSIB) Senior Safety Investigator, Helen Jones, blogs about some of the key benefits and risks of electronic patient record (EPR) systems used in healthcare, sharing what we are learning from our safety investigations.

Content

Recurring themes identified through safety investigations

Since 2018, HSSIB has published nine investigations in which there were specific findings and safety recommendations relating to EPR systems:

Interoperability

A key finding in a number of our investigations was the lack of interoperability between the EPR and other IT systems across services. This relates to the ability of computer systems or software to exchange information.

Usability testing of software

A key finding in a number of our investigations was that EPR systems had not undergone usability testing. This is a method of testing the functionality of an EPR system by observing real users as they attempt to complete tasks in the environment they work in.

Standards and standardisation of the software and systems

It has been seen that the EPR systems staff are asked to use have not incorporated human factors engineering principles. Testing and standards can help ensure that staff and patient interactions with the EPR system can be better understood to help identify the systems strengths and weaknesses and identify potential errors that could result in harm to patients. HSSIB have made safety recommendations to national organisations to help improve EPR systems by:

• Ensuring EPR systems undergo human factors and usability assessments to ensure their functionality and safety for staff and patients.
• Ensuring manufacturers are provided with additional guidance to meet the above requirements.
• Commissioning research into how EPR systems can be best configured to avoid staff experiencing ‘alert fatigue’. This is where too many alerts may lead to users paying less attention to them.
• Ensuring EPR systems consider the whole patient pathway in relation to discharge from hospital and not just acute care.
• Improving interoperability between different systems in the prisons system.

The new NHS ‘federated’ data platform will enable every NHS trust and integrated care system to connect and share information between them. This type of digitised, connected system would enable services to be delivered more effectively and efficiently, with the patient front and centre.

For this system, or any EPR system, to help ensure improved patient safety, organisations need to:

• Plan for interoperability or what the process will be if EPR systems are not interoperable.
• Utilise human factors and user-centred design input to help design systems to be the best they can be.
• Commit to usability testing with the staff and patients who will use the system, in the environment the EPR system will be used in, to best reflect ‘real world’ work.