NIST releases EHR usability protocol

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The National Institute of Standards and Technology (NIST) has outlined formal procedures for evaluating the usability of EHRs.

The proposed useability protocol encourages a user-centered approach to the development of EHR systems, according to NIST. “It provides methods to measure and address critical errors in user performance before those systems are deployed in a medical setting.”

“This guidance can be a useful tool for EHR developers to demonstrate that their systems don’t lead to use errors or user errors,” said NIST researcher Matt Quinn. “It will provide a way for developers and evaluators to objectively assess how easy their EHR systems are to learn and operate, while maximizing efficiency.”

The protocol is a three-step process consisting of an analysis of how the application functions, expert review and validation testing of the user interface to make sure it works as intended:

Step 1: EHR Application Analysis: The application analysis is both a key component of user-centered development processes and the foundation for the protocol and all subsequent analysis and testing activities. The analysis can rely heavily, where applicable, on the EHR application developer’s user requirements and system requirements analysis. These elements include a description of the application’s basic functions, analysis of the user characteristics, task analysis describing the interactions between users and the application, analysis of the anticipated environment of use related to interactions with the application, and the identification of critical user tasks related to aspects of patient safety. The application analysis should provide a description of the design of the application’s user interface and how the design has been optimized via iterative formative and exploratory useability assessments during development

Step 2: EHR User Interface Expert Review: The review is conducted by a combination of the vendor’s development team and a dedicated team of clinical safety and useability experts. The evaluators compare the EHR’s user interface design to scientific design principles and standards, and identify design issues that could lead to safety risks.

Step 3: EHR User Interface Validation Test: The test evaluates actual user performance on critical patient safety-related tasks identified in the previous steps, including a validation test conducted by qualified usability/human factors professionals prior to EHR implementation/deployment. Performance is examined by collecting user performance data that are relevant indicators of the presence of safety risks. Performance also is evaluated by conducting post-test interviews focused on what users identify as risks based on confusion or misunderstanding when carrying out directed scenarios of use.

“We hope this encourages system developers to apply human factors best practices and incorporate user-centered design processes,” said Quinn. “These practices and processes have proven records in industries such as aviation, military systems, transportation, nuclear power and others where safety is a concern.”

The protocol is available on NIST’s website