Table 1.
Patient safety practice adoption by primary care settings with and without EHR, years 2006–2010, n=209.
| Expected relationship to EHR | Items | % Fully implemented n=209* | Sig.** | |
|---|---|---|---|---|
| Paper n=117 | EHR n=92 | |||
| Medications (16 items) | ||||
| Yes | Patients receive up-to-date medication list at each visit | 10.3% | 44.6% | 0.000 |
| Yes | E-prescribing system in place | 17.9% | 94.6% | 0.000 |
| Yes | Documentation system (manual or electronic) for all prescribed medications and renewals | 57.3% | 91.3% | 0.000 |
| Yes | All prescribing practice staff have access to drug information and CDS for medications | 88.0% | 96.7% | 0.001 |
| Possible | Detailed records/log on all vaccines dispensed | 74.8% | 90.6% | 0.001 |
| Possible | Review of all medications and side effects with documentation at every visit | 70.1% | 85.9% | 0.005 |
| Possible | Complete medication history including over-the-counter medications | 82.9% | 92.4% | 0.016 |
| Possible | List of high-alert drugs relevant to practice that require direct physician-pharmacist contact | 37.6% | 54.3% | 0.020 |
| Possible | Tracking system in place for all patients on warfarin | 71.0% | 81.6% | 0.119 |
| No | Indication for all medications on all prescriptions | 19.7% | 44.6% | 0.000 |
| No | Medications in practice checked regularly for expiration dates | 88.9% | 98.9% | 0.000 |
| No | Detailed labeling of all multi-dose injectable vials | 64.9% | 83.3% | 0.000 |
| No | Detailed labeling of all dispensed medications including samples | 57.0% | 81.7% | 0.000 |
| No | External medications labeled and stored separately | 52.1% | 71.7% | 0.009 |
| No | Up-to-date medication information for non-English speakers | 30.8% | 43.5% | 0.072 |
| No | All child bearing age females required to have pregnancy test before teratogens prescribed | 60.7% | 60.9% | 0.382 |
| Handoffs and Transitions (11 items) | ||||
| Yes | Practice tracks all laboratory and pathology testing | 68.4% | 85.9% | 0.013 |
| Possible | Process for learning and recording essential new information about patient from outside practice | 63.2% | 85.9% | 0.001 |
| Possible | Patients have easy access to all laboratory and consult results | 70.1% | 83.7% | 0.006 |
| Possible | All test results are communicated to patient in timely manner (24–48 hours) | 72.6% | 87.0% | 0.010 |
| Possible | Confirm/record patient discharge from hospital/facility | 71.8% | 81.5% | 0.027 |
| Possible | System in place to track critical versus routine laboratory and pathology tests | 88.0% | 93.5% | 0.060 |
| Possible | Practice has process to communicate all medications when patient admitted to hospital/facility | 79.5% | 87.0% | 0.110 |
| Possible | Transfer of patient is clear with new clinician responsibility accepted including patient records | 70.9% | 72.8% | 0.330 |
| Possible | System in place for imaging test tracking | 67.5% | 77.2% | 0.337 |
| Possible | Consultation tracking system in place | 57.3% | 68.5% | 0.480 |
| No | Practice identifies in-office emergent situations with process in place to address them | 82.1% | 90.2% | 0.010 |
| Personnel/Qualifications/Competency (6 items) | ||||
| No | Employees educated about new drugs/products by staff/practitioners (not sales representatives) | 52.1% | 71.7% | 0.000 |
| No | System to periodically assess physician competency | 65.8% | 82.6% | 0.000 |
| No | Orientation to policies and procedures for nursing/technical staff | 91.5% | 100.0% | 0.000 |
| No | Orientation to policies and procedures for all new physicians/PAs/NPs | 84.6% | 92.4% | 0.001 |
| No | System to periodically assess nursing/support staff competency | 82.1% | 87.0% | 0.004 |
| No | Practice maintains system for continuing education | 70.9% | 83.7% | 0.018 |
| Practice Management/Culture (20 items) | ||||
| Possible | Patients instructed on proper use/maintenance of prescribed devices | 80.3% | 94.6% | 0.001 |
| Possible | Essential patient information clear and easily accessible to appropriate office personnel | 95.7% | 95.7% | 0.318 |
| No | Practice encourages patients to share safety concerns in writing or in surveys | 70.9% | 87.0% | 0.000 |
| No | When errors/near misses occur, open educational efforts used that include all personnel | 76.9% | 92.4% | 0.002 |
| No | All office staff are HIPAA trained | 90.6% | 97.8% | 0.004 |
| No | Practice has protocols for emotional support for all staff involved in adverse events | 68.4% | 75.0% | 0.005 |
| No | Job descriptions for all office staff include requirements to speak up about safety issues | 73.5% | 85.9% | 0.005 |
| No | All practice staff trained to recognize and manage health literacy issues | 53.8% | 72.8% | 0.005 |
| No | Practice provides training to all staff in team communication | 69.2% | 87.0% | 0.005 |
| No | Error reduction principles reviewed at orientation and performance evaluations | 65.8% | 87.0% | 0.006 |
| No | System for reporting potential threats to patient safety/near misses | 78.6% | 93.5% | 0.009 |
| No | Job descriptions for all clinical staff include requirements to speak up about safety issues | 74.4% | 85.9% | 0.013 |
| No | System in place for reporting errors supported by culture of safety and openness | 85.5% | 94.6% | 0.015 |
| No | Practice uses established tools to monitor staff fatigue/morale | 60.7% | 75.0% | 0.018 |
| No | Safe treatment environment provided | 89.7% | 98.9% | 0.063 |
| No | All patient complaints are documented and reviewed | 76.1% | 91.3% | 0.097 |
| No | Patients are informed of HIPAA | 98.3% | 100.0% | 0.123 |
| No | Measuring device suggested for prescribed oral liquids | 78.6% | 85.9% | 0.206 |
| No | Practice uses current literature on adverse events for practice improvement | 58.1% | 60.9% | 0.493 |
| No | Staff feel comfortable requesting time away | 94.9% | 96.7% | 0.604 |
| Patient Education/Communication (13 items) | ||||
| Possible | Practice assists patients in obtaining educational materials/resources on their conditions | 78.6% | 94.6% | 0.021 |
| Possible | Diagnostic/treatment care plans clearly communicated to patient and caregivers | 65.0% | 87.0% | 0.028 |
| Possible | Patients receive critical information (verbal and written) in lay terms about new prescriptions before leaving office | 49.6% | 63.0% | 0.042 |
| Possible | Patients are assessed for financial and physical ability to obtain prescriptions/supplies | 65.8% | 78.3% | 0.062 |
| Possible | Patient life-style information collected and used for care plan | 86.3% | 93.5% | 0.169 |
| Possible | Chronic disease patients identified and monitoring services provided | 83.8% | 88.0% | 0.246 |
| Possible | Process for timely email/phone correspondence with patients and other practitioners | 87.2% | 93.5% | 0.829 |
| No | Patients and caregivers instructed to ask questions regarding medications | 70.1% | 91.3% | 0.000 |
| No | Interpreters are available for LEP/hearing impaired patients | 63.2% | 79.3% | 0.001 |
| No | Patients are routinely asked to repeat back instructions | 61.5% | 73.9% | 0.010 |
| No | Patients’ participation sought in decisions regarding their care | 94.9% | 97.8% | 0.039 |
| No | Patients asked to repeat back information and instructions they receive on phone | 52.1% | 62.0% | 0.320 |
| No | Practitioner explains to patients all risks for procedures and testing | 85.5% | 93.5% | 0.454 |
*Note: “% Fully implemented“ includes responses “fully implemented in the practice for some areas, patients, drugs, procedures and/or staff,” and, “fully implemented in the practice for all areas, patients, drugs, procedures and/or staff.”
**Calculated based on estimating gamma (γ).