EHR Usability

The purpose of the SHARPC project began as an exploration of how to provide cognitive support to physicians using Electronic Health Records (EHRs).

EHRs will provide “Patient-Centered Cognitive Support” when they are specifically designed and optimized to support problem solving and decision making that maximizes the chance of providing the highest quality of care for patients, as measured by IOM’s six dimensions of quality (safe, effective, timely, efficient, equitable, and patient-centered).

  • At the work domain level, the ideal EHR will have an explicit, unified, accurate, and comprehensive model that reflects the true ontology of the work domain and provides a clear understanding of the care problem, independent of how it is implemented within the system. Some systems suffer from models of the work domain that are implicit, multiple, unconnected, disparate, incomplete, and often inaccurate.
  • At the representation and implementation level, ideal EHRs should have clear, comprehensive, easy to navigate information and knowledge models optimized for human users. Some systems have representations that are based on hardware and software features, making them confusing, siloed, task-specific, difficult to use & learn, and hard to navigate because they do not match human expectations. 
  • At the level of task performance, an ideal EHR will “build-in” safe, timely, effective, efficient, equitable, patient-centered task performance. Some systems seem disconnected, redundant, tedious, and use unclear user models based on billing and legal requirements that actually interfere with task performance.

The projects under the NCCD umbrella have responded to the changing aims at the ONC.

SHARPC has made notable contributions to the science of usability, specifically in the context of EHRs, Recommendations generated from the project helped to inform EHR usability guidelines published by the National Institute of Standards and Technology (NIST). Recommendations from several of the projects informed inclusion of Safety Enhanced Design in the EHR certification criteria for the 2014 Meaningful Use for EHRs.