NIST guide aims to improve EHR usability, enhance patient safety

The National Institute of Standards and Technology (NIST) has released a new guide aimed at making electronic health records more usable and thus safer.

The guide offers recommendations to eliminate "never events" and associated patient harm by proactively addressing and mitigating the root causes of user errors from EHR design and implementation issues.

Using five different methods of data collection, the researchers found three major problems associated with EHRs causing suboptimal and unsafe patient care: problems with identification, consistency and integrity of the information, such as inability to retrieve information from the record; lost data; and information in multiple locations. They also found several recurring issues: unintended actions, the likelihood of use errors and a "high level" of user frustration.

The guide provides empirically based guidance for safety-enhanced design in three areas:

  • Consistently displaying information critical to patient identification in a reserved area to avoid wrong patient errors
  • Providing cues to reduce risk of entering information into the wrong patient chart
  • Supporting efficient and easy identification of inaccurate, outdated or inappropriate information in lists of grouped information by having information presented simply and in a well-organized manner

"Ultimately, this research demonstrates that patient safety is negatively affected when critical safety tasks are performed with the support of poorly designed EHRs," the guide states. "As a result, mistakes and errors frequently occur; with end users becoming frustrated and unwilling to trust the systems they are given and therefore are more likely to rely on potentially unsafe workarounds."

NIST also recommends validation testing to ensure safety enhanced design.

EHR-related patient safety issues are an ongoing concern, although changes to improve EHR-related patient safety have not come as quickly as some have hoped. The Joint Commission recently issued a sentinel alert about the problem, along with several recommendations for reducing harm to patients.

ONC has released guides in an attempt to reduce EHR-related errors and improve patient safety; AHRQ also is funding research on this problem.

To learn more:
- read the guide (.pdf)

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