Bad EHR design can lead to data entry errors and risky workarounds that could jeopardize patient safety, according to a new document from NIST, which outlines ways to spot critical areas of risk and methods for improving user-centered design.

Aiming to provide an "empirical rationale" to drive standardized patient safety-focused usability guidelines, the NIST report takes aim at so-called "never events," working proactively to mitigate root causes of electronic health record use errors caused by suboptimal design and implementation.

"The ultimate goal is to drive and empower effective and safe human performance in the use of EHRs," officials write.

Researchers looked at five methods of human performance data collection, drawn from "different disciplines, backgrounds and perspectives." Multiple forms of data were gathered from these varying user types, enabing a more comprehensive look at the many ways EHRs are used.

Two multi-hospital health systems served as sites for most of the data collection, including observations and interviews, according to NIST. Methods included an online survey, site observations, follow-up interviews with users, usability testing of five different EHR systems and expert reviews of those EHRs.

The research showed "strong congruence" among those data, methods and analysts, according to NIST, which has subsequently developed human-factors guidelines for standardization derived from that evidence.

They focus on three key risk areas:

1. Consistently displaying information critical to patient identification in a reserved area to avoid wrong patient errors;
2. Providing cues to reduce  the  risk 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 Supporting efficient and easy identification of inaccurate, outdated, or inappropriate items in lists of grouped information by having that data presented clearly and in a well-organized manner.

Identification, consistency and integrity of information are essential to safety, the report shows, but oftentimes bad EHR design can put them at risk, as when "highly frustrated" clinicians make use of workarounds such as "paper 'shadow charts' or whiteboards," according to NIST, which offers two use cases – one inpatient, one ambulatory – to validate that potential patient safety risks are proactively mitigated in the tested EHRs.

"Ultimately, this research demonstrates that patient safety is negatively affected when critical safety tasks are performed with the support of poorly designed EHRs," according to NIST. 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."

Read NIST's report here.