Patient safety concerns in the go-live phase of an electronic health record implementation

BACKGROUND: Transitions to new electronic health record systems can disrupt workflows and patient safety. At Helsinki University Hospital, the Epic Radiant imaging module went live in April 2021 as part of the Apotti electronic health record rollout. OBJECTIVE: To characterise patient safety incidents associated with the Radiant go-live and identify contributing factors for safer future implementations. METHODS: We analysed three sources: radiology-targeted patient safety incident reports from six months before to six months after go-live; a one-time free-text screen of reports made by radiology units one month after go-live, used to identify Radiant-related reports targeted outside radiology; and root cause analysis minutes for serious incidents in IT Management during the six months after go-live. Incidents were classified by type, risk level, seriousness, and Radiant-relatedness. RESULTS: Radiology-targeted reports increased from 161 before to 296 after go-live. Of 284 non-serious post-go-live reports, 100 were Radiant related. The most common categories were information flow and data management and imaging processes. Delayed or missing examinations or reports predominated, usually at risk levels II-III with no, low, or unspecified recorded harm. The free-text screen identified 72 additional Radiant-related reports targeted outside radiology. Serious radiology-targeted incidents increased from 1 before to 12 after go-live; 11 were Radiant related and mainly involved prolonged MRI or CT reporting delays affecting high-risk patients. Root cause analyses from IT management highlighted increased workload, changed work procedures, insufficient end-to-end testing, and interoperability failures. CONCLUSIONS: Radiant implementation coincided with a cluster of incidents, notably serious delays in imaging reporting, linked to integration gaps and workflow strain. End-to-end interface testing, code-set harmonisation, clear surge procedures and active post-go-live monitoring may mitigate risks.