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Vendors can promote EHR usability and safety in all aspects of design and development, implementation, and post-implementation processes, in addition to supporting other stakeholders—see the suggestions that follow.
For a comprehensive report on what you can do, view our team’s related report with The Pew Charitable Trusts: “Ways to Improve Electronic Health Record Safety: Rigorous Testing and Establishment of Voluntary Criteria can Protect Patients.”
Design and Development
Employ a user-centered design process. Involve clinicians when designing and developing an EHR by conducting interviews and observations to understand clinical workflow and needs of the end user. Investing time to understand the user early in the design and development process has long-term payoffs. Resources include:
- AllScripts white paper: “Improving EHR Usability with User-Centered Design”
- UTHealth “General Design Principles for EHRs”
Conduct rigorous software evaluation, including usability testing, in line with regulatory guidance from the National Institute of Standards and Technology (NIST). It is important to conduct both formative and summative usability testing. Summative testing should include the use of realistic clinical scenarios that represent common tasks as well as infrequent tasks. Resources include:
- NIST “Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records”
- UTHealth Test Cases for Specific Safety Enhanced Design Requirements
- Agency for Healthcare Research and Quality (AHRQ) EHR Usability Toolkit
- Electronic Health Record Association (EHRA) Personas Resources
- Our report with Pew, which is referenced and linked in the introduction
Use existing design resources and best practices as guidelines, and follow design standards. Resources include:
Implementation
Guide providers during implementation. EHR vendors have a tremendous amount of experience and expertise with EHR technology, while providers may not have nearly as much. The large variation in usability and safety across sites with the same EHR vendor has been observed and documented by our teams and others.
Understand pain points experienced by healthcare institutions—and how the size and resources of an institution can affect its experience. MedStar Health and other researchers have started to collect real-world user experiences with their EHR implementations. Using these insights could help prevent future implementation challenges.
Post Implementation
Support a national database for usability and safety reporting. Just as the Food and Drug Administration (FDA) maintains the Manufacturer and User Facility Device Experience databases that allow vendors and users to report medical issues, the Office of the National Coordinator for Health Information Technology (ONC) can establish and maintain a central database of EHR usability and safety issues.
Read this February 2019 Journal of the American Medical Association (JAMA) article underscoring the importance of publicly reporting these issues.
In the meantime, EHR vendors can:
- Promote knowledge sharing between users of your products. Health System A may have discovered that the design of its medication pick-lists was leading to wrong medication errors. Hospital B and Small Clinic C may be experiencing these same issues but have struggled to pinpoint a potential cause. Promote knowledge sharing by immediately disseminating any known safety issues and solutions to all clients to help mitigate usability challenges on a large scale.
- Work with a patient safety organization. The EHR usability and safety hazards that may be reported to you by clients should also be analyzed and used to improve products. Sharing this information with patient safety organizations as well allows for vendor liability protection while also enabling the data to be leveraged to identify common usability and safety challenges on a broader scale that reaches beyond your clients. Contact AHRQ to find out more.
Other Important Activities
Participate in the American Medical Association’s (AMA) “EHR Connect” platform. EHR Connect brings together key stakeholders for enhanced collaboration around EHR development, usability, optimization, and interoperability for improved end-user experiences with EHRs. Join EHR Connect to share your voice, learn from others’ expertise and experiences, and access news, events, and resources on the topic.
Join the Partnership for Health IT Patient Safety. ECRI Institute has created this multi-stakeholder collaborative to discuss and make health information technology, including EHRs, safer.
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