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11/1/2011
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NIST: Make EHRs More User-Friendly

National Institute of Standards and Technology solicits input on how to make electronic health records better, safer.

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The National Institute of Standards (NIST), in conjunction with public and private sector stakeholders, has called on the healthcare community to help evaluate electronic health records (EHRs), examine the human factors that are crucial to their design, and assist with guidance on the development of usability engineering practices.

An October 27 webcast focused on NIST's recently released Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records, draft guidelines that review the rationale for an EHR usability protocol (EUP).

The guidelines outline procedures for expert evaluation of an EHR user interface from clinical and human factors best-practices perspectives. They also offer guidance on how to conduct validation studies of EHR user interfaces with representative user groups on realistic EHR tasks.

[For background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch.]

"NIST's research and development is focusing on creating a specific methodology that will allow testers to objectively evaluate and measure usability in order to identify critical issues in the application, if any, prior to application deployment," Svetlana Lowry, NIST project lead for health IT usability, told InformationWeek Healthcare. "The most successful applications are products from vendors that can be easily and accurately used by providers. The NIST research and development goal is to support vendors in the development process by guiding them with best practices."

According to the draft guidelines document, there is consensus among many clinicians that EHRs could be simpler to use and that they can introduce user errors that could be harmful to patients. Furthermore, the ability to use EHRs with ease will encourage eligible hospitals and physician practices to adopt them, apply for reimbursements under the Medicare and Medicaid EHR incentive programs, and avoid penalties if they don't do so by 2015.

Emily Patterson, assistant professor at Ohio State University's college of medicine, noted during the webcast that research shows there are "critical use errors of electronic health records systems" that need to be addressed to help physicians and other clinicians mitigate mistakes when using EHRs.

Patterson said such errors can occur, for example, when accessing the wrong patient record, which can result in actions being performed for one patient that are intended for another. EHRs can also store incomplete information on a patient because of an inability to access and update the patient's notes from another provider. Additionally, there can be inadequate feedback, such as when a partial dose of medication in an inpatient setting is automatically converted to a higher dose of that medication when the patient is discharged from the hospital.

During the webinar, Dr. Chris Gibbons, associate director at Johns Hopkins Urban Health Institute, said aligning verbal documentation with EHRs can also cause difficulties in an inpatient care setting. "It's frequent that physicians give verbal orders; how those are handled within the EHR can be problematic," Gibbons said. He explained that workflow interruptions are likely to occur in a very busy clinical setting.

"While a provider is entering information many things could occur [including emergencies] that interrupt his input of that information into the electronic medical record. After a period of time has elapsed ... there could be timeout delays where after a certain period of inactivity all information previously entered is lost, which would then require the provider to start over," Gibbons observed.

To tackle these and related issues, the draft guidelines provide a three-step process for EHR design evaluation and human user performance testing that incorporates both the evaluation and validation procedures. The steps are as follows:

1. Usability/human factors analysis of the application during EHR user interface development,
2. Expert review/analysis of the EHR user interface after it is designed/developed, and
3. Testing of the EHR user interface with users.

The NIST health IT usability initiative is being conducted in collaboration with the office of the national coordinator for health IT (ONC) and the Agency for Healthcare Research and Quality (AHRQ). NIST has asked EHR vendors, health IT managers, and other health stakeholders to submit comments on the draft guidelines by November 10.

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Lisa Henderson
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Lisa Henderson,
User Rank: Apprentice
11/3/2011 | 1:22:57 AM
re: NIST: Make EHRs More User-Friendly
Having experience writing in other industries, there are many that go through stringent steps before purchasing a vendor's software, and others that do purchase on the fly. I think that this may be a combination of the culture, like you mention ...hosptials and physicians just accept what is offered and the fact that there is so much to choose from right now, they don't know what to choose or have the time for that kind of process.

Lisa Henderson, InformationWeek Healthcare, contributing editor
TMONTGOMERY760
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TMONTGOMERY760,
User Rank: Apprentice
11/2/2011 | 2:12:46 PM
re: NIST: Make EHRs More User-Friendly
Lisa is correct. This will lead to problems and possible documenation errors which could directly impact the patient or other providers giving care to that patient. I have worked in healthcare for more than 20 years so this is not just an option. Hospitals and physicians seem to accept whatever software vendors offer them. I think they make decisions on the vendor name rather than strict requirements.
Lisa Henderson
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Lisa Henderson,
User Rank: Apprentice
11/1/2011 | 11:29:29 PM
re: NIST: Make EHRs More User-Friendly
So this would be an issue....if you pump all this money in the system for people to develop and use EHRs, but then the EHRs themselves are not helpful or functional or usable, and the physician or hospital or medical group adopts a lousy EHR from a standards function, isn't that going to cause some downstream issues in a few years?

Lisa Henderson, InformationWeek Healthcare, contributing editor
AWESTERINK024
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AWESTERINK024,
User Rank: Apprentice
11/1/2011 | 5:32:18 PM
re: NIST: Make EHRs More User-Friendly
Usability is unquestionably the greatest complaint regarding EHRs among physicians. There is a great advantage to be gained from and EHR that is designed based on first hand research and time spent with physicians in their practice. http://www.vitalblog.com
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