MedStar Health researchers examine alleged misrepresentation of EHR capabilities with potentially significant implications for patient safety

A research letter available today in the JAMA Health Forum advocates for more rigorous security practices among EHR vendors.

COLUMBIA, MD., November 11, 2022 /PRNewswire/ — Researchers from MedStar Health, Brigham and Women’s Hospital and the University of Utah found that electronic health record (EHR) provider misconduct may have led to widespread use of suboptimal products for more than 70,000 clinicians across the country, as published today in the JAMA Health Forum. Six EHR vendors have been involved in settlements with the U.S. Department of Health and Human Services Inspector General’s Office and the U.S. Department of Justice alleging bribery and misrepresentation of product capabilities .

Raj Ratwani, PhD, vice president of scientific affairs at the MedStar Health Research Institute and lead author of the research paper published today in the JAMA Health Forum.

In addition to creating incentives for healthcare organizations to adopt the use of EHRs, the Health Information Technology for Economic and Clinical Health Act of 2009 held that EHR products should be certified as meeting the capability, functionality, and safety requirements adopted by HHS. Violation of this rule can result in complaints and in turn settlements with the DOJ, but unfortunately oversight is limited.

After reviewing every publicly available settlement related to EHR certification violations, MedStar Health researchers found that six EHR vendors had reached settlement agreements totaling more than $379.8 million, with four of the six vendors involved in settlements related to misrepresentation of product functionality to achieve certification. Based on data from the Centers for Medicare & Medicaid, it is estimated that more than 76,831 unique clinicians used these six providers during the complaints period.

“The widespread use of EHRs has helped providers and healthcare organizations better manage care for their patients. But what if providers can’t be sure that the EHR platform they’re using is safe, secure and can be used effectively? says Raj Ratwani, PhD., vice president of scientific affairs for the MedStar Health Research Institute, director of the MedStar Health National Center for Human Factors in Healthcare, and senior author of this article. “These data show that even a handful of examples of EHR provider misbehavior can have a significant impact on patient safety and how providers use these platforms.”

Insights to make EHRs more secure

Today’s release builds on MedStar Health’s Human Factors team’s exploration of the role that EHR systems can play as a contributing factor to overall patient safety, including a study of 2018 which found that EHR use issues may have contributed to harmful events in some healthcare settings.

In addition to examining the design of EHRs, MedStar Health investigators sought to develop actionable solutions to help make EHRs more secure through two primary initiatives:

1) Develop resources for healthcare organizations to proactively monitor and identify opportunities to optimize the functionality of their EHR platform. More recently, this includes creating an assessment tool that can be used to assess alerting, data entry, and automation processes, as well as visual display.

2) Offer recommendations for higher security standards in the EHR market. Examples of this work include advocating for HHS to develop a national database for usability and safety reports and encouraging the Joint Commission to adopt accreditation requirements that would incentivize hospitals to implement EHR security best practices.

“The importance of our work in this area is that we can improve EHRs as a critical tool for healthcare facilities and patient safety at the same time,” Dr. Ratwani said. “While we have made incremental progress, success depends on greater transparency in the industry, as well as a shared commitment from governing bodies, health system customers and providers to work together to give the safety first.”

Ratwani RM, Apathy NC, Bates DW, Classen DC, Hettinger AZ, Howe JL, Krevat SA. Legal agreements on electronic health records in the United States since the Health Information Technology for Economic and Clinical Health Act of 2009. JAMA Health Forum. 2022;3(11):e223872. doi:10.1001/jamahealthforum.2022.3872

About MedStar Health

At MedStar Health, we use the best of our minds and the best of our hearts to serve our patients, their caregivers, and our communities. Our 30,000 Associates and 4,700 Affiliate Physicians are committed to delivering on this promise through our SPIRIT Core Values: Service, Patient First, Integrity, Respect, Innovation and Teamwork, in our more than 300 locations, including 10 hospitals, ambulatory care centers and urgent care centers. As a medical education and clinical partner of Georgetown University, MedStar Health trains future physician leaders to care for the whole person and advances care through MedStar Health Research Institute. From our telemedicine and urgent care services to the region’s largest home care agency, we are committed to providing high quality healthcare that is also easy and convenient for our patients. At MedStar Health, this is how we treat people. Learn more about

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