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EHR Usability and Patient Safety

Posted By Administration, Tuesday, November 03, 2015

Report from the National Institute of Standards and Technology Provides Guidelines

Poorly designed electronic health record (EHR) systems can lead to user errors or to frustrated users who resort to work-arounds that further erode patient safety.

The National Institute of Standards and Technology (NIST) recently conducted research into the usability of EHRs and has issued guidelines for usability testing and standardization to enhance safety. The guidelines are targeted at preventing ‘never events’ and associated patient harm by proactively addressing and mitigating the root causes of errors linked to EHR design and implementation elements.

The P.S. Blog talked with lead author Lana Lowry, of the NIST Information Technology Laboratory, to learn more about the new guidelines.


P.S. Blog: What are the chief recommendations of the NIST report?

Lana Lowry: The recommendations based on the chief findings of our data analysis are provided to improve safety-related usability of EHRs in the three critical use-risk areas related to the display of critical information in the electronic record to support tasks. These are:

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 Supporting efficient and easy identification of inaccurate, outdated, or inappropriate items in lists of grouped information by having information presented simply and in a well-organized manner. 

P.S. Blog: Were there any surprises in what the investigators found during this work?

LL: There were several consistent themes across the data, and much of the findings are not surprising. However the consistent reporting of issues is something to take note of, and these issues were easy to understand. The EHR must be trustworthy in its content, consistent in display of critical information, and by design must make it difficult for the user to make a mistake by writing in the wrong chart.

P.S. Blog: How do you hope health care professionals, health IT vendors, or others will use these guidelines?

LL: The purpose of this work is to improve safety for patients by enhancing safety-related usability of the electronic record. Hopefully the use-cases developed by NIST will be used to test and improve existing electronic records, and our standardization guidelines will be applied to design safer systems.


The NIST report, Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records: Empirically Based Use Cases for Validating Safety Enhanced Usability and Guidelines for Standardization, is available for download at no charge on the National Institute of Standards and Technology website at

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Contact the P.S. Blog by writing to the editor, Patricia McTiernan, at


Tags:  EHR  elctronic health record  Health IT  HIT  NIST 

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