Increasing EHR system usability through standards: Conformance criteria in the HL7 EHR-system functional model.

Though substantial work has been done on the usability of health information technology, improvements in electronic health record system (EHR) usability have been slow, creating frustration, distrust of EHRs and the use of potentially unsafe work-arounds. Usability standards could be part of the solution for improving EHR usability. EHR system functional requirements and standards have been used successfully in the past to specify system behavior, the criteria of which have been gradually implemented in EHR systems through certification programs and other national health IT strategies. Similarly, functional requirements and standards for usability can help address the multitude of sequelae associated with poor usability. This paper describes the evidence-based functional requirements for usability contained in the Health Level Seven (HL7) EHR System Functional Model, and the benefits of open and voluntary EHR system usability standards.

Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.

Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.

Improving EHR Usability Using LEAN Methodology.

Electronic health record (EHR) usability concerns continue to reduce EHR effectiveness. LEAN methodology, which focuses on waste elimination, may provide an effective method to address efficiency related usability deficiencies. We aimed to improve the usability of an inpatient seclusion and restraint (SR) EHR module using LEAN methodology. A multidisciplinary team convened to evaluate and redesign clinical and technological SR workflows using LEAN techniques, including process mapping and time-series analyses. SR module modifications addressed 40 of the 60 efficiency related usability deficiencies identified in the initial SR module. Usability enhancements included elimination of 10 nonessential inputs, 21 redundancies, and nine overhead functions. Process steps were reduced from 74 to 47. Improving EHR usability is critical to assure safe, effective, and efficient care1. We demonstrated that LEAN methodology is an effective method to address efficiency related EHR usability deficiencies. More research is needed to determine how these improvements impact care quality.