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NIST Offers Guidance for EHR Usability with Aim to Enhance Patient Safety

October 15, 2015
by Rajiv Leventhal
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The National Institute of Standards and Technology (NIST) has released a new guide aimed to enhance the usability of electronic health records (EHRs), which would in turn improve patient safety.

While evidence suggests that the use of health IT may help address significant challenges related to healthcare delivery and patient outcomes, studies have also found that patient mortality unexpectedly increased following the introduction of an EHR in a pediatric hospital and that an order-entry system contributed to a severe medication overdose. Therefore, empirically-derived guidelines for standardization are needed to foster enhanced ability to protect patients from inadvertent harm from EHRs, according to NIST.

Researchers applied a multiple research methods approach in order to triangulate user interactions, experience and dispositions of common encounters with EHRs. Multiple forms of data were collected from a variety of user types allowing for a comprehensive view of EHRs.

The researchers found three overarching themes representing critical areas of use risk, based upon a convergence of triangulated evidence from all of the data sources: identification of information, consistency of information, and integrity of information. The research also found that across all three of the risk areas and their related subcategories there arose several major issues related to patient safety: 1) the occurrence of unintended actions; 2) the likelihood of use errors; and 3) the high level of user frustration.  The three areas and their related issues highlight a lack of effectiveness and efficiency related to EHRs, researchers stated.

As such, a team composed of a methodologist, clinical physicians, clinical nurses and human factors experts provided guidance on the generation of the recommendations and use case during a focused two-day working meeting. They included:

  • Consistently display information critical to patient identification in a reserved area to avoid wrong patient errors
  • Provide visual cues to reduce risks of entering information and writing orders in the wrong patient’s chart
  • Support efficient and easy identification of inaccurate, outdated, or inappropriate items in lists of grouped information by having information presented simply and in a well-organized manner

“Ultimately, the data from this study demonstrate that during safety-critical tasks and times, patient safety is negatively affected, in part because mistakes and critical use errors occur more frequently and because users are highly frustrated, and thus more likely to employ workarounds, such as relying upon supplemental artifacts, e.g., paper ‘shadow charts’ or whiteboards,” the guide concluded. “In accordance with the empirical evidence, and in order to make care more optimal and safe, we provided human factors guidance for improving the usability of EHRs.”




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