Daniela Young


September 2008

Document Type


Degree Name



Dept. of Biomedical Informatics and Clinical Epidemiology


Oregon Health & Science University


Background: EHRs and CPOE promise to improve quality and safety of healthcare, but published evidence suggests the potential for harm as well. Efforts like CCHIT have emerged to develop standards that ensure safety of EHR and CPOE systems, but no standards exist to ensure that users possess the competencies to use these systems safely. Objective: This thesis address the question: What competencies must a physician possess in order to use an EHR system safely? Methods: These three phase projects consist of: -Phase I: Creation of a complete set of competencies developed from four source documents, resulting in 138 competencies. -Phase II: Refinement of the list from phase I using a survey form filled by mid-career informatics trainees. In this phasee the lower scored competencies were eliminated resulting in a list of 50 competencies. -Phase III: Ranking of the list from phase II using a survey and national experts in EHR development and implantation. From the resulting ranked list the top 25 competencies were selected. The analysis of the survey was done using the Kendall-Wei method and the Dominant-Matrix program. This method allowed us to analyze the data even if data was missing and allowed us to rank the list with just one round of questions. Results: The top competency in the list was the use of key idenification to look up a unique patient record. The resulting top twenty five competencies a physician should have in order to use an EHR system safely are mostly involved with medication management, and order entry. Other top competencies topics included: Drug interactions, manage allergy and adverse reaction list, and manage problem list, pharmacy communication, and medication or immunization administration. The coefficient of agreement between raters was 0.55. Conclusion: -There is a strong agreement between experts that medication related competencies are the most important competencies. -Identifying the correct patient record is a top requirement. -There was a strong agreement about the top 25 competencies. In order to increase safety of EHR systems changes should be made in two areas: -More focus on safety in use of EHR and CPOE. -Verify that the physician users possess the key competencies for safe use. -The certification of EHR systems should emphasize the safety of identification, medication, and ordering features.




School of Medicine



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.