eHealth Hazards

Some recent reports on US and UK electronic health records and health apps are giving cause for concern. An 8 September 2015 ScienceDaily article based on materials provided by  JAMA – Journal of the American Medical Association  reports on the Lack of adherence to usability testing standards for electronic health record products. The Summary notes that “The lack of adherence to usability testing standards among several widely used electronic health record (EHR) products that were certified as having met these requirements may be a major factor contributing to the poor usability of EHRs”

The article gives details of The U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) certification requirements for usability practices by EHR vendors, including formal usability testing on 8 different EHR capabilities to ensure the product meets performance objectives. However, analysis of the user-centered design (UCD) reports for the 50 EHR vendors with the highest number of providers (hospitals and small private practices) shows that many of the certified EhR products have not met the usability testing requirements.

The authors conclude that “The lack of adherence to usability testing may be a major factor contributing to the poor usability experienced by clinicians. Enforcement of existing standards, specific usability guidelines, and greater scrutiny of vendor UCD processes may be necessary to achieve the functional and safety goals for the next generation of EHRs.”

Another reason for the poor usability of EHRs comes from a 22 September 2015 ScienceDaily  article based on materials provided by the American College of Emergency Physicians. Transitioning through electronic health records reports that “Even after emergency physicians had acclimated to a new commercial electronic health record, they increased their tasks performed per minute by nearly 12 percent, increasing the potential for patient safety hazards. These are the results of a study of one hospital’s transition from a homegrown EHR to a commercial EHR.”

The article describes how Researchers studied the workflow for three periods: “pre-implemention of the EHR, one week following widespread use of the EHR (“go-live”) and 3 to 4 months after the EHR was implemented.”  The results show the increase in time spent and tasks performed under the new EHR. The lead study author  concluded “Our study highlights important differences between homegrown EHRs and commercial EHRs. Homegrown EHRs tend to be customized to the workflow processes of the specific hospital and ER. The increased task-switching we observed may be the result of the lack of customization in commercial EHRs. Moving forward, it will be important to determine whether commercial EHRs can be easily customized to better meet the workflow needs of emergency department staff and prevent cognitive burn-out from task-switching.”

Our April 2015 Newsletter included an article on health apps: Developers Neglect Privacy, Security in Health Apps. Now  a new warning comes in a 24 September 2015 ScienceDaily article based on materials provided by BioMed Central. “Information handling by some health apps not as secure as it should be” reports on a review of 79 apps that were listed on the UK NHS Health Apps Library in July 2013 and are available on Android and iOS platforms. The article notes that “Use of smartphone health apps is now at an all-time high. It is currently estimated that one and a half billion smartphone users have a health app installed and this number is set to treble in the next three years.” The researchers from Imperial College London, UK, and Ecole Polytechnique CNRS, France, found that “ Some health apps that have been clinically accredited may not have been complying with principles of data protection… In some instances health apps were found to be sending unencrypted personal and health information, which means users of these apps may have had their privacy put at risk.”

Lead researcher, Kit Huckvale, Imperial College London, UK, commented: “Our study suggests that the privacy of users of accredited apps may have been unnecessarily put at risk, and challenges claims of trustworthiness offered by the current national accreditation scheme being run through the NHS. The results of the study provide an opportunity for action to address these concerns, and minimize the risk of a future privacy breach. To help with this, we have already supplied our findings and data to the NHS Health Apps Library.”