- A team of researchers from Pew Charitable Trusts and MedStar recommended ONC develop more rigorous, specialized EHR usability and safety testing for pediatric EHR certification in a recent JAMA article.
EHR vendors and healthcare organizations need to design different systems for children and adult patients, researchers maintained. Some problems with EHR usability can pose a higher risk to pediatric patients than adult patients.
“For example, children often receive drug dosages based on weight, yet the poor usability of some EHRs has contributed to pediatric patients overdosing on medications,” wrote researchers.
“Similarly, clinicians use EHRs to help administer age-based care, such as vaccinations,” researchers continued. “Suboptimal usability can contribute to errors, such as failures by clinicians to administer age appropriate vaccinations.”
Optimizing pediatric EHR systems with a focus on usability improvements may help to reduce the potential for EHR-associated patient harm.
The 21st Century Cures Act calls upon ONC to create a voluntary EHR certification program tailored to the specific needs of pediatric care. By developing a more rigorous EHR certification program for pediatric EHR systems, researchers suggested ONC could help to spur needed improvements in usability and patient safety.
Ben Moscovitch and Josh Rising, MD, from Pew Charitable Trusts and MedStar National Center for Human Factors in Healthcare Senior Research Scientist and Scientific Director Raj Ratwani, PhD, offered ONC five recommendations to strengthen and improve usability testing for pediatric EHR systems.
First, the group recommended ONC implement stricter criteria for certification requirements related to user-centered design (UCD).
UCD comprises a set of processes that identify and prioritize the needs of end users during software development. Current ONC certification requirements mandate that EHR vendors attest to using a UCD process through a written statement. This requirement is too lax, researchers stated.
“The new ONC program could follow the model of requiring evidence of UCD, with a focus on the tasks and functions (such as weight-based dosing) needed by clinicians when treating pediatric patients,” suggested researchers.
Requiring that EHR vendors provide documentation of design changes made based on user feedback or other evidence of the UCD process will help to ensure EHR systems meet the needs of clinicians.
Next, researchers urged ONC to require that usability test participants accurately represent intended end users.
“If the test participants do not represent the intended end users, then it is unlikely that usability and safety hazards will be identified, because the test participants do not have the appropriate clinical knowledge to use the product as it would be used in real-world settings,” researchers maintained.
Pediatricians, pediatric nurses, and other members of pediatric care teams should participate in usability testing for EHR systems designed for the care of children.
Researchers also suggested ONC include rigorous test cases in the usability and safety certification process.
“Test cases serve as the primary way to identify challenges with EHR usability and can support the identification of hazards, such as confusing displays and ambiguous alerts,” explained researchers. “To identify these types of usability challenges, the test cases used by vendors to assess their products should represent realistic clinical scenarios and tasks.”
Test cases used to assess pediatric EHR usability and safety should focus on EHR functionality that pose the greatest potential risk to patients.
A new ONC pediatric EHR certification program should clearly define what constitutes a rigorous test case so EHR vendors can better identify usability and safety challenges.
Next, researchers advised that ONC extend usability testing to include the entire EHR lifecycle — including development, implementation, and customization.
“The detection of usability-associated hazards should not conclude with certification; rather, the unique workflows of facilities, customization requested by health care organizations, and other factors can also affect EHR functionality,” researchers wrote.
Finally, the team highlighted the importance of encouraging EHR vendors to offer transparency into their products’ level of usability and safety.
“Little information currently exists on the usability and safety of EHR products,” researchers said. “Several barriers exist to the availability of those data, including contracts signed between EHR vendors and health care organizations that prohibit the sharing of screenshots and other information on usability.”
Encouraging healthcare organizations to share information about usability and safety across vendor systems may help to boost transparency. Additionally, researchers suggested ONC develop different reporting measures for pediatric EHR users that offer regulatory bodies a window into system usability.
Overall, demarcating pediatric and adult EHR systems and ensuring EHR vendors include unique functionality to help providers best care for pediatric patients may help to improve patient safety.
“The ONC, in implementing the 21st Century Cures Act, can rectify that gap to decrease the likelihood of patient harm associated with EHRs,” concluded the team.