Abstract
Background Electronic health records (EHRs) are transforming the way health care is delivered.
They are central to improving the quality of patient care and have been attributed
to making health care more accessible, reliable, and safe. However, in recent years,
evidence suggests that specific features and functions of EHRs can introduce new,
unanticipated patient safety concerns that can be mitigated by safe configuration
practices.
Objective This article outlines the development of a detailed and comprehensive evidence-based
checklist of safe configuration practices for use by clinical informatics professionals
when configuring hospital-based EHRs.
Methods A literature review was conducted to synthesize evidence on safe configuration practices;
data were analyzed to elicit themes of common EHR system capabilities. Two rounds
of testing were completed with end users to inform checklist design and usability.
This was followed by a four-member expert panel review, where each item was rated
for clarity (clear, not clear), and importance (high, medium, low).
Results An expert panel consisting of three clinical informatics professionals and one health
information technology expert reviewed the checklist for clarity and importance. Medium
and high importance ratings were considered affirmative responses. Of the 870 items
contained in the original checklist, 535 (61.4%) received 100% affirmative agreement
among all four panelists. Clinical panelists had a higher affirmative agreement rate
of 75.5% (656 items). Upon detailed analysis, items with 100% clinician agreement
were retained in the checklist with the exception of 47 items and the addition of
33 items, resulting in a total of 642 items in the final checklist.
Conclusion Safe implementation of EHRs requires consideration of both technical and sociotechnical
factors through close collaboration of health information technology and clinical
informatics professionals. The recommended practices described in this checklist provide
systems implementation guidance that should be considered when EHRs are being configured,
implemented, audited, or updated, to improve system safety and usability.
Keywords
interfaces and usability - sociotechnical aspects of information technology - electronic
health records - patient safety - medical informatics
