AHRQ Study: Many Electronic Health Record Systems Have Limited Capabilities in Graphing Lab Results

A new AHRQ-funded study found that many electronic health record (EHR) systems have significant limitations in their graphing capabilities for laboratory test results, which could have serious implications for clinical decision-making and patient safety. The study evaluated the graphical displays in eight EHRs using 11 evaluation criteria based on literature and expert opinion. For example, researchers evaluated labeling and data distribution in the test results graphs for accuracy and clarity. Researchers found that many commonly used EHRs did not meet several of the evidence-based criteria aimed at improving provider understanding of laboratory data, with no EHR meeting all 11 criteria. The authors recommended that as EHRs become more widely implemented and used in clinical decision-making, policymakers need to ensure that these systems clearly and accurately display lab results. The study, “Graphical Display of Diagnostic Test Results in Electronic Health Records: A Comparison of Eight Systems,” was published online March 19 in the Journal of the American Medical Informatics Association.

Abstract

Accurate display and interpretation of clinical laboratory test results is essential for safe and effective diagnosis and treatment. In an attempt to ascertain how well current electronic health records (EHRs) facilitated these processes, we evaluated the graphical displays of laboratory test results in eight EHRs using objective criteria for optimal graphs based on literature and expert opinion. None of the EHRs met all 11 criteria; the magnitude of deficiency ranged from one EHR meeting 10 of 11 criteria to three EHRs meeting only 5 of 11 criteria. One criterion (i.e., the EHR has a graph with y-axis labels that display both the name of the measured variable and the units of measure) was absent from all EHRs. One EHR system graphed results in reverse chronological order. One EHR system plotted data collected at unequally-spaced points in time using equally-spaced data points, which had the effect of erroneously depicting the visual slope perception between data points. This deficiency could have a significant, negative impact on patient safety. Only two EHR systems allowed users to see, hover-over, or click on a data point to see the precise values of the x–y coordinates. Our study suggests that many current EHR-generated graphs do not meet evidence-based criteria aimed at improving laboratory data comprehension.