By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies
Many current commercial electronic health records (EHRs) have "significant limitations" in graphing laboratory test results, according to a study published online March 19 in the Journal of the American Medical Informatics Association. The authors say that nonstandardized display of results has patient safety implications if test data is not communicated clearly and accurately.
"With wider implementation of EHRs, more clinicians will rely on automatically-generated computerized displays that allow clear and accurate visual synthesis of data over time," write the authors led by Dean Sittig, from the University of Texas Health Science Center in Houston. "Suboptimal displays could have serious implications for clinical decision-making."
The authors say highlighting current system limitations is necessary in light of the fact that there have been legislative attempts (so far unsuccessful) to limit the U.S. Food and Drug Administration’s oversight over EHRs. One recent proposal specifically excluded software “intended to format, organize, or otherwise present clinical laboratory test report data prior to analysis, or to otherwise organize and present clinical laboratory test report findings or data” from oversight.
As part of an Agency for Healthcare Research and Quality-funded study focused on management of abnormal laboratory test results, the researchers evaluated the graphical displays of laboratory test results (chronological, numerically-reported) in eight EHRs. They used objective criteria for evaluating optimal graphs based on literature and expert opinion. Of the EHRs, bodies approved by the Office of the National Coordinator for Health Information Technology certified six, one was a prototype system, and one was the Veterans Affairs system.
The researchers found that none of the EHRs met all 11 evaluation criteria. One system met 10 of the 11 criteria, while three systems only met five of 11 criteria. All systems failed to display a graph with y-axis labels that display both the name of the measured variable and the units of measure. One EHR system graphed results in reverse chronological order. Another system plotted data at unequally-spaced points in time using equally-spaced data points, which had the effect of "erroneously depicting the visual slope perception" between data points. This deficiency, the authors say, could have a "significant, negative impact on patient safety." Only two systems allowed users to see, hover over, or click on a data point to see the exact values of the x–y coordinates.
"We recommend policymakers ensure clear and accurate visual display of laboratory data through more stringent Office of the National Coordinator for Health Information Technology authorized testing and certification bodies EHR certification testing criteria," writes Sittig. "Our study also underscores the need to inform frontline providers, who might depend on graphs in their day-to-day clinical decision-making, to be careful to review the basic components of their EHRs’ graphs to ensure they understand exactly what each data point represents."