# Patient safety incidents associated with EMR use: Results of a national survey of Swiss physicians

## TL;DR

Swiss physicians reported EMR-related safety incidents, with usability and ordering issues being most common, highlighting the need for better EMR design.

## Contribution

This study reveals previously unreported EMR-related safety incidents and emphasizes the importance of clinician feedback in improving EMR systems.

## Key findings

- 23.9% of surveyed physicians reported EMR-related safety incidents in the past four weeks.
- Half of these incidents were not formally reported, indicating underreporting of EMR-related risks.
- Usability and ordering functionalities were the most frequently cited issues.

## Abstract

Electronic medical records (EMRs) are increasingly recognized as a contributing factor to patient safety incidents. Clinicians’ experiences can reveal EMR-related risks that may otherwise go unnoticed. This study explores EMR-related patient safety incidents reported by physicians across diverse care settings, institutions, and EMR products.

A national sample of Swiss physicians was surveyed online and asked whether they had experienced a patient safety incident related to EMR use within the previous four weeks. Free-text descriptions of incidents were analyzed thematically using a structured, multi-step procedure.

Of the 1933 inpatient and outpatient physicians who completed the survey, 23.9% (n = 398) reported experiencing an EMR-related safety incident in the previous four weeks. Half of these incidents (49.7%) had not been formally reported (e.g. through critical incident reporting or IT channels). A total of 385 incident descriptions were analyzed, revealing seven emergent themes: (1) patient identification and selection errors (16.7%), (2) system reliability and performance issues (15.8%), (3) interoperability and system integration (8.8%), (4) usability, interface, and design problems (21.8%), (5) system errors and unexpected behavior (8.8%), (6) security and access control (2.6%), and (7) problems with order entry, decision support, alerting, and verification (25.2%). There were considerable differences in the patterns of events reported in relation to the used EMR system.

Physicians reported a broad range of EMR-related safety problems, particularly related to ordering functionalities and usability, many of which were not formally recorded. In addition to broader socio-technical strategies, such as user training, incident reporting, and alignment with clinical workflows, systematically incorporating clinicians’ experiences into EMR design is required to guide advancements in patient safety.