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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: