title: Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users.
abstract: BACKGROUND
  The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system.
  
  
  OBJECTIVE
  This study addresses two important questions: (1) "which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?", and (2) "which variables are associated with high- and extreme-risk severity ratings?"
  
  
  METHODS
  This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach's alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined.
  
  
  RESULTS
  A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type "extended EHR unavailability". The lowest overall risk level was associated with "selecting incorrectly from a list of items". In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest ( P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels ( P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors.
  
  
  CONCLUSIONS
  Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately.
authors.affiliation: University of Eastern Finland, Faculty of Social Sciences and Business Studies, Department of Health and Social Management, Kuopio, Finland. sari.palojoki@hus.fi.
authors.forename: Sari
authors.identifier: http://orcid.org/0000-0003-3047-9713
authors.initials: S
authors.lastname: Palojoki
authors.forename: Tuuli
authors.identifier: http://orcid.org/0000-0001-8412-0584
authors.initials: T
authors.lastname: Pajunen
authors.forename: Kaija
authors.identifier: http://orcid.org/0000-0002-3195-1955
authors.initials: K
authors.lastname: Saranto
authors.forename: Lasse
authors.identifier: http://orcid.org/0000-0002-3443-3838
authors.initials: L
authors.lastname: Lehtonen
keywords: Electronic Health Records; Health Information Technology; Patient Safety; Questionnaire; Risk Assessment