Objectives Electronic medical records (EMRs) are increasingly recognized as a contributing factor to patient safety incidents. Clinicians’ experiences can reveal EMR-related risks that may otherwise go unnoticed. This study explores EMR-related patient safety incidents reported by physicians across diverse care settings, institutions, and EMR products. Methods A national sample of Swiss physicians was surveyed online and asked whether they had experienced a patient safety incident related to EMR use within the previous four weeks. Free-text descriptions of incidents were analyzed thematically using a structured, multi-step procedure. Results Of the 1933 inpatient and outpatient physicians who completed the survey, 23.9% (n = 398) reported experiencing an EMR-related safety incident in the previous four weeks. Half of these incidents (49.7%) had not been formally reported (e.g. through critical incident reporting or IT channels). A total of 385 incident descriptions were analyzed, revealing seven emergent themes: (1) patient identification and selection errors (16.7%), (2) system reliability and performance issues (15.8%), (3) interoperability and system integration (8.8%), (4) usability, interface, and design problems (21.8%), (5) system errors and unexpected behavior (8.8%), (6) security and access control (2.6%), and (7) problems with order entry, decision support, alerting, and verification (25.2%). There were considerable differences in the patterns of events reported in relation to the used EMR system. Conclusions Physicians reported a broad range of EMR-related safety problems, particularly related to ordering functionalities and usability, many of which were not formally recorded. In addition to broader socio-technical strategies, such as user training, incident reporting, and alignment with clinical workflows, systematically incorporating clinicians’ experiences into EMR design is required to guide advancements in patient safety.
Schwappach et al. (2026) studied this question.