A $1 million grant awarded to Oregon Health & Science University (OHSU) by the Agency for Healthcare Research and Quality (AHRQ) will fund research to address some of the challenges connected to EHRs and create smarter EHR systems.

“Most tools used in medicine require knowledge and skills of both those who develop them and use them,” said William Hersh, MD, professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU. “Even tools that are themselves innocuous could be detrimental to patient care if used improperly.”

For example, Hersh explained that while it is difficult to cause direct harm with a stethoscope, improper use of a stethoscope could lead to inaccurate results, tests or treatments. Similarly, improper use of EHRs could lead a clinician astray, especially in the Intensive Care Unit (ICU) where an average of 1,300 data points per patient are logged every 24 hours.

The grant, championed by Jeffrey Gold, MD, will put OHSU at the forefront of this work. Through his past role as ICU director and current role as professor of medicine and program director for Pulmonary Critical Care and Critical Care Fellowships, Gold became interested in this work when he noticed that EHRs weren’t consistently providing clinicians with a clear picture of a patient’s health over time.

“In the past, all patient data was hand written, making it easier to remember and learn,” said Gold. “Electronic records are no doubt a useful tool in many ways, but now there are so much data in front of you that often you can’t see the forest for the trees.”

Gold, who is the principal investigator on the grant, will work with Hersh and his informatics team to develop a simulation environment based on real ICU cases that will utilize cutting-edge technology such as eye-tracking sensors. Gold and his team will purposely build in errors or changes in the hypothetical patient’s condition to test whether users can catch them. The simulations will help determine how clinicians interact with the amount of data contained in EHRs. Gold will then harness these findings to improve EHRs by developing ways to clearly organize patient information in a practical and meaningful way.

“What makes this novel is, as far as we’re aware of, we’re the only ones using simulation to try to test EHRs usage,” Gold said. “We’re building a better mouse and a mouse trap at the same time.”

While EHRs can improve communication, create truly portable medical records and improve overall patient safety, a 2011 report issued by the Institute of Medicine (IOM) indicates greater oversight is needed to realize potential benefits.

The risk with EHRs, Gold explained, is that there are blind spots in the technology, due to unnecessary or excessive information that clutters the ‘big picture’ of a patient’s care. The grant will allow Gold to research ways to address these risks.

“Using these simulated cases does not only train people how to use the system but also helps us determine how EHRs are being used in a structured and intelligent environment,” said Gold.

Gold will soon co-direct the simulation center at OHSU’s new Collaborative Life Sciences Building, which is set to open winter 2014.