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“Flight simulator” tool to monitor medications in electronic health records

January 12, 2021


Photo: ©iStock/xavierarnau

A tool developed more than a decade ago by VA researchers to simulate the way electronic health records (EHRs) process clinicians’ medication orders has recently been shown to reduce harm to patients throughout the United States. The tool, nicknamed a “flight simulator” because of its similarity to the aviation training tool of the same name, is being used not only at VA facilities but in more than 2,100 hospitals nationwide.

Since VA first deployed modules of an EHR to twenty VA facilities in 1978, the department has been a champion of EHRs and their value to patients and clinicians. Today’s VA system includes safeguards to help stop clinicians from prescribing drugs that may harm patients. These safeguards include automatic alerts provided by the system to clinicians when they enter information on a patient’s record that they plan to order medications that could harm or even kill the patient.

These alerts, however, are not failsafe. A study published in 2020 showed that in hospitals where EHRs are extensively used, there was significant variation in the ability of different systems to detect medication errors—putting the health of many patients in danger.

VA’s way of addressing this problem is the model most hospitals now use to reduce the frequency of these errors. To evaluate the safety performance of its own system in actual operation, in 2008 VA researchers deployed a tool to test medication safeguards by simulating the way EHRs process clinicians’ medication orders.

The “flight simulator” tool detects whether a system’s programming allows clinicians to enter medication orders that might cause problems, and reviews the types of alerts clinicians receive when they attempt to order such medications. It uses a series of dangerous scenarios based on actual adverse drug events such as drug allergies, drug to drug interactions, and excessive dosing to test the system’s responses, without putting any actual patients in harm’s way.

VA’s tool is available free to hospitals throughout the United States as part of the Leapfrog Hospital Survey, an annual, voluntary, safety-related survey of U.S. hospitals. More than 2,100 hospitals used the tool in 2018. Another 2020 study found that, while there is still substantial safety risk in many hospital EHR systems, the tool significantly improved performance at those hospitals using it.

“VA was proud to participate in the original development of this test, and we think it’s important to frequently validate that our electronic systems are protecting patients from common prescribing errors,” concludes Dr. Jonathan Nebeker, VA’s acting Chief Medical Informatics Officer.

Principal investigator: Dr. David C. Classen, VA Salt Lake City Health Care System

Selected publications:

National trends in the safety performance of electronic health record systems from 2009 to 2018. Classen DC, Holmgren AJ, Co Z, Newmark LP, Seger D, Danforth M, Bates DW. JAMA Netw Open. 2020 May 1:3(5):e205547.

The tradeoffs between safety and alert fatigue: Data from a national evaluation of hospital medication-related clinical decision support. Co Z, Holmgren AJ, Classen DC, Newmark L, Seger DL, Danforth M, Bates DW. J Am Med Inform Assoc. 2020 Aug 1;27(8):1252-1258.

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