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NIST report suggests changes in EHR design, features

March 17, 2014
by Richard R. Rogoski
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A recently published report by the National Institute of Standards and Technology recommends that developers of electronic health records (EHRs) and the clinicians that use them refocus their efforts to better integrate EHRs into clinical workflow.

In many cases, EHRs are more often relied on to simplify the billing process rather than being used as an aid in patient care, the report says. The new recommendations affect the types of data collected as well as suggesting changes in the environments where EHRs are used to collect data.

The report's recommendations also may be valuable to long-term care environments and their acute-care partners, while also serving as an acknowledgment of the features used by LTC's mobile data entry platforms. After interviewing physicians and looking at workflow modeling tools, the report offers suggestions to both EHR developers and clinicians in ambulatory care centers.

For EHR developers, the recommendations suggest features for:

• Drafting pre-populated orders to be formally executed later;

• Supporting drafting documentation with shorthand notations without a keyboard;

• Designing EHRs for empathetic body positioning and eye contact with the patient while personally interacting with the EHR and while sharing information on the EHR screen with the patient and family members; and

• Verifying alarms and alerts and data entry without "hard stops."

For ambulatory care centers, NIST recommends:

• Designing rooms to support patient rapport and EHR access;

• Minimizing redundant data entry from interoperability;

• Reducing clinic pace or increase flexibility of pace;

• Ensuring functionality that supports continuity in the task performance in the case of interruption; and

• Minimizing requirements to enter detailed data for others (administrators, billing/coding, legal, accreditation) during fast-paced patient visits.

"Overall, our recommendations provide a first step in moving from a billing-centered perspective on how to maintain accurate, comprehensive, and up-to-date information about a group of patients to a patient-centered perspective," the report notes. "This perspective more centrally revolves around the needs of primary care providers, including physicians, physician assistants, and nurse practitioners. These recommendations point the way towards a 'patient visit management system,' which incorporates broader notions of supporting workload management, supporting flexible flow of patients and tasks, enabling accountable distributed work across members of the clinical team, and supporting dynamic tracking of steps in tasks that have longer time distributions."