Research funded by AHRQ’s Digital Healthcare Research Program aims to support clinicians and other healthcare professionals in providing health services. In 2019, total program investment in research to support clinical decision making was $71 million over the duration of the projects. The research projects highlighted below share the goal of improving the experience of health professionals who use electronic health records (EHRs) and other digital healthcare technology. The featured researchers investigated how health professionals interact with technology and how technology can be optimally integrated into daily tasks.
Improving Clinical Decision Making hinges in part on clinicians’ ability to access the most relevant and recent information to make evidence-based decisions regarding a patient’s healthcare. AHRQ funds research to expand the evidence base to ensure that clinicians have the tools to put research-based information into practice, including the following:
To increase rates of immunization coverage, Dr. Melissa Stockwell implemented an immunization clinical decision support (CDS) tool that combines data from an immunization information system registry with medical history data from an EHR to deliver patient-specific immunization reminders to providers. This synchronization of data resulted in an increase in vaccinations for individual patients but did not impact rates in the study population.
Improving Usability and EHR Design is often a key component of efforts to improve decision making and patient care. Intuitive navigation and clear configuration of EHR systems are imperative for provider usability. The following research highlights the use of design improvement for EHRs and other digital healthcare technology:
Dr. Pascale Carayon developed design requirements for a computerized CDS tool to enhance the prevention and diagnosis of venous thromboembolism (VTE). The design, which focuses on interactions between people and technology in the workplace, resulted in greater usability for clinicians when compared to a pre-existing VTE CDS tool.
Dr. Aaron (Zach) Hettinger explored the adaptation of a “black box,” the flight data recorder used to analyze and prevent aviation errors, to improve EHR systems. The methodology captures mouse movements and keystrokes by EHR end users so they can be used for root cause analysis of errors. The research found that the health IT black box methodology can identify and facilitate the review of EHR-based errors that inform improvements in EHR design and usability.
Improving Health Technology Design to Decrease Provider Burden is a focus of AHRQ-funded research aimed at addressing EHR-related provider burden. The following research explored ways to improve technology design and use, including clinical workflow, communication, cognitive load, and user satisfaction to reduce provider burden:
Dr. Ann Kutney-Lee investigated the relationship of EHR usability, adoption, environments, and outcomes to explore correlations between EHR usability, patient outcomes, and the well-being of nurses. The study’s findings revealed a strong relationship between work environment and EHR usability, implying that nurses were likely involved in the selection and implementation of the EHR systems. The researchers concluded that involving nurses in the development, selection, and modification of EHR systems should be a priority for EHR vendors and hospital administrators.
Dr. Genevieve Melton-Meaux developed a visualization tool to highlight new information in clinical EHR notes. EHR clinical notes typically contain a lot of redundant information, making it difficult for end users to recognize clinically important new information. This automated method was designed for providers to quickly identify crucial new information and reduce the cognitive burden of navigating data-rich EHRs.
Dr. John Windle developed a set of best practices for EHR design to educate vendors about clinical providers’ wants and needs. The guidance involved building functional wireframe models to improve clinical workflow, communication among users, and patient care and safety.