How to Leverage Health Information Standards to Boost EHR Usability

Developing and implementing a human-centered design (HCD) into the EHR can boost EHR usability and aid clinicians when reviewing patient data charts, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Furthermore, leveraging new health information standards, such as Fast Healthcare Interoperability Resources (FHIR), could help accelerate this approach.

Reviewing relevant patient data, especially in a fast-paced environment such as the emergency department (ED), is challenging for clinicians. EHR users are forced to find and read specific information that could be scattered across multiple EHR workflows. This information is often displayed in a spreadsheet format that makes it difficult for a clinician to recognize patterns or trends.

Although healthcare organizations have successfully implemented human-centered design (HCD) approaches to combat this issue, many designs aimed to track patient care or resource allocation across the ED, wrote the study authors.

The researchers aimed to evaluate clinician time spent in the EHR, number of workflows, information retrieval accuracy, cognitive load, clinician satisfaction, and perceived usefulness.

The research team utilized FHIR standards to develop and implement a HCD approach into the Children’s Hospital of Philadelphia (CHOP) ED. This approach, called the Asthma Timeline Application, can display an individual’s asthma history within the EHR to support care interventions.

“Recent developments in health information exchange standards, such as Fast Healthcare Interoperability Resources (FHIR), are starting to make multisite deployments more feasible,” wrote the study authors. 

“FHIR is a data exchange specification that makes use of open internet standards, which offer a lightweight alternative to simple object access protocol, and supports both JavaScript object notation, and extensible markup language,” the researchers continued.

Following implementation, users reported a significant reduction in EHR use time, number of screens used, and cognitive workload. Respondents also noted high user satisfaction and reliable functionality.

Some clinicians found EHR visualization without EHR interaction also provided clinical value because of the quick snapshot of the patient’s asthma history, the study authors wrote.

“This finding is consistent with research that suggests current EHRs are limited in their abilities to provide easy-to-access and interpretable graphical reviews of patient data,” the study authors continued. 

“Additionally, though we initially focused on a single disease, since asthma is a chronic condition that requires continual follow up over many years, we believe our visualization can generalize well to other chronic conditions, such as sickle cell disease.”

Utilizing HCD approaches could mitigate EHR usability issues that lead to clinician burnout, the study authors explained.

Boosting EHR usability while decreasing task load could allow clinicians to decrease cognitive burden, which then allows for better patient care and improved decision making.

There is a growing connection between EHR usability and clinician burnout. EHR usability issues typically result in an increase in cognitive load and errors, which can lead to patient safety issues. And this problem is cyclical; the higher the cognitive load, the more a clinician has to use the EHR, which can further lead to burnout.

“Having recognized the impact EHR usability can have on both patients and clinicians, our approach was informed by other efforts to use HCD approaches,” the study authors explained. “As such, we adapted and combined evidence-based methods, both quantitative and qualitative, that allowed us to evaluate the impact/effort of next steps and iterate on design rapidly.”

The study authors proposed this approach could serve as a future model for research teams in other healthcare domains.

The tool was limited to one major healthcare institution that has abundant resources, the researchers acknowledged. Not all healthcare organizations have HCI specialists, software engineers, informatics-trained clinicians, and custom CDS framework.

“This work demonstrates the feasibility of developing, implementing, and evaluating a custom application embedded in a commercial EHR that decreases providers’ mental workload while caring for children with asthma in a pediatric ED,” concluded the study authors.