Medical Errors and Health IT: What Does the Data Say?

Health information technology (IT) is a powerful tool for documenting and sharing information about patients’ health and helping providers to make well-informed decisions about patient care. However, problems relating to health IT, including both system and user issues, are also sometimes cited as factors in causing or contributing to patient harm—and even lawsuits.

Patient Safety

Problems related to health IT can cause patient harm, including serious harm or death. A 2017 systematic review of health IT problems and their effect on patient outcomes and care delivery found that health IT problems were associated with patient harm and death in 53% of the studies reviewed. Use errors and poor user interfaces impeded the receipt of information and led to errors of commission in decision-making. Problems with system functionality (including poor user interfaces and fragmented displays), system access, system configuration, and software updates caused delays in care delivery. Several studies characterized medication errors related to health IT problems in more detail.

In 2012, ECRI's Patient Safety Organization (PSO) published "Deep Dive: Health Information Technology," which reviewed 171 health IT-related events submitted by PSO member healthcare facilities during a nine-week period. Of the 124 events for which a harm score was entered, 8 events (6.4%) resulted in patient harm: 3 events may have caused or contributed to the patient's death, 1 event required life-sustaining intervention, 1 required hospitalization, and 3 resulted in harm requiring other types of intervention. An additional 24 events (19%) required monitoring to confirm that there was no harm or need for intervention.

The most commonly involved systems were:

• Computerized provider order entry system (25%)
• Clinical documentation system (17%)
• Electronic medication administration record (15%)
• Laboratory information system (13%)
• Pharmacy system (11%)
• Human interface device (e.g., computer not functioning) (9%)
• Radiology or diagnostic imaging system (8%)

The most common problem types were:

• Data transfer: System interface issue (16%)
• Data input: Wrong input (14%)
• General technical: System configuration software issue (13%)
• Data output: Wrong record retrieved (11%)

Health IT-related medication errors continue to receive particular attention. In an analysis of patient safety event reports from more than 595 healthcare facilities entered between 2013 and 2018, researchers identified 1,508 event reports describing medication errors associated with health IT use, 50% of which reached the patient. Wrong dose errors were by far the most common medication error type (81%). Nearly all reports (97%) described a usability issue, most commonly problems with data entry (43%), workflow support (30%), alerting (16%), and system automation and defaults (6%).

Lawsuits and Insurance Claims

Issues relating to health IT are increasingly cited as contributing factors in lawsuits and claims. A Doctors Company claims analysis published in 2019 found that the percentage of claims alleging that EHRs contributed to patient injury generally increased from 2010 to 2018, from a low of 0.35% in 2010 to a peak of 1.62% in 2016. Usually, EHRs were contributing factors, not the primary cause of the claim. The most prevalent injuries were death (25%) and adverse reaction to a medication (23%). The most common allegations were diagnosis-related (31%). The most common specific system technology and design issues were:

• Electronic systems or technology failure of the EHR (12%)
• Lack or failure of EHR alert or alarm (7%)
• Fragmented record (6%)

The most common user-related issues were:

• Incorrect information (13%)
• Prepopulation or copy and paste (13%)
• Hybrid health record or EHR conversion issue (13%)
• User error (other) (12%)
• Training and/or education (7%)

A 2019 study of CRICO claims coded from 2012 through 2014 analyzed 248 cases identified as having one or more EHR-related contributing factors. For the years 2013 and 2014, 0.84% of all cases coded during that period were identified as having one or more EHR-related contributing factors. These issues more often occurred in ambulatory settings (59%) than inpatient (31%) or emergency (10%) settings. The most common system-related issues were:

• System and software design (15%)
• Routing of electronic data (9%)
• System dysfunction or malfunction (8%)

The most common user-related issues were:

• Miscellaneous user error (17%)
• Hybrid health record or EHR conversion issue (14%)
• Incorrect information (13%)
• Prepopulation or copy and paste (8%)

The most common allegations related to medications (31%), diagnosis (28%), medical treatment (14%), and surgical treatment (13%). The severity of harm was higher in inpatient and emergency settings than in ambulatory settings.

Learn how ECRI can help you reduce risks related to health IT, support safety efforts, and achieve better outcomes with our comprehensive approach to safety.