The National Institute of Standards and Technology has released a new guide to improve the usability and safety of electronic health records, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 10/12).

Guide Details

For the guide, researchers collected data through five different methods:

• An online survey;
• Follow-up interviews with users;
• Site observations;
• Usability testing of five different EHRs; and
• Expert reviews of those EHRs (Lowry et al., NIST guide, October 2015).

According to FierceEMR, the researchers noted three significant issues associated with EHRs leading to suboptimal and unsafe patient care:

• Information stored in several locations;
• Issues with identification, consistency and integrity of the information; and
• Lost data.

The researchers also noted several recurring issues, including:

• A "high level" of user frustration;
• The likelihood of use errors; and
• Unintended actions (Durben Hirsch, FierceEMR, 10/12).

Recommendations

The guide provides recommendations for eliminating "never events" and related patient harm by addressing the causes of EHR use errors in design and implementation (NIST guide, October 2015).

The guide recommends that EHRs be designed to:

• Display information key to patient identification consistently in a designated place to prevent wrong patient errors;
• Offer cues to lower the risk of inputting information into the incorrect patient chart; and
• Present information in a clear, well-organized manner to support identification of incorrect information in lists of grouped information.

In addition, NIST recommended validation testing for EHRs to ensure safety-enhanced design (FierceEMR, 10/12).