Use of Dense Display of Data and Information Design Principles in Primary Care Health Care Information Technology Systems

Recent articles in peer-reviewed and popular literature have identified usability and information design shortcomings as reasons for poor adoption of electronic health records (EHRs) and for creating new categories of errors in care delivery. Yet the usability of EHR systems, while recognized as critical for successful adoption and meaningful use, has not historically received the same level of attention as software features, functions, and technical requirements. Little systematic evidence has been gathered on the usability of EHRs in practices and how their design affects cognitive task flow, continuity of care, and efficiency. Further, the role of EHRs in patient care is evolving significantly as adoption is incentivized, health information exchanges are activated, and new forms of comparative evaluations are codified and made available for clinical decision support. This project established a foundation and action agenda for the use of dense data display and other innovative information design principles in primary care health information technology applications.

The main objectives of the project were to:

• Complete a detailed background report containing a comprehensive summary of the literature to serve as the basis for the final report.
• Conduct an innovation meeting with a group of experts in diverse areas related to the EHR and its design. The innovation group will define an ideal user interface for a primary care physician. This involves indicating how EHRs are and are not being used optimally. Additional considerations include patient safety and risk, efficiency, and the impact of having scattered information.
• Compile a set of recommendations on principles and policy and a research agenda.
• Compile a set of "use cases."
• Complete a final report that integrates the background report and the output from the innovation meeting.
• Interview a wide array of providers of ambulatory EHR products and develop recommendations to assess and improve the state of usability in EHR systems.

The technical expert panel made specific research-related and policy-related recommendations. In addition to these recommendations, the panel characterized the evolving role of four primary functions of the EHR in supporting clinical practice. These functions include aids for memory, computation, decision support, and collaboration. Finally the project expert panel made vendor specific recommendations based on feedback they received during interviews with EHR vendors.

All of the recommendations may be seen in the final reports prepared by the project team.