The test scenarios are based on actual patient safety reports that involve technology and potential harm. This information led to the development of: Use of the voluntary certification tenets and test cases by health care facilities and technology developers can improve the usability and safety of EHRs. And failures of systems to issue alerts about harmful medication interactions—situations that can stem from changes made by facilities, how clinicians enter data, or EHR design—could lead to medical errors. The Leapfrog Group, a nonprofit organization founded by large employers and health care purchasers to improve health care safety and quality for their employees, sponsors an EHR test utilizing test cases in its annual hospital safety survey. 4 (2010). Some EHR developers and health care providers may choose to adopt the criteria to improve the safety and usability of systems. Reduce cognitive workload 6. See the costs for all the AMA membership categories, plus tax deduction information. That’s where EMRs help. The AMA partnered with MedStar Health's National Center for Human Factors in Healthcare to develop an evaluation framework on the usability of EHRs. The template provides a standardized format for each of the test cases, detailing: Below is an example of a basic scenario. An extensive AMA-RAND Corporation study (PDF) on physician satisfaction led the AMA to provide eight EHR requirements. Expedite user input into product design and post-implementation feedback The … The theft or loss of desktops, notebooks, smartphones, tablets, USB keys, or portable hard drives, and the inappropriate disposal or transmission of patient files are among the common sources of privacy breaches. Most efforts to improve public health surveillance over the past two decades have focused on electronic laboratory surveillance. All rights reserved. 6 (2014): 1053-59. Improve care coordination. Michael Todd Huber, MD, Janelle Deneen Highland, MA, MPP, Venkatesan Ram Krishnamoorthi, MD, MPH, and Joyce Wing-Yi Tang, MD, MPH. Tech advancements — such as voice recognition, digital scribes, and connected … The current EHR certification program—implemented by the federal Office of the National Coordinator for Health Information Technology (ONC)—is intended to set the baseline standards that EHRs must meet so that hospitals and health care providers can confidently adopt and use the technology to meet requirements in certain federal programs. Another health system reported that it had found ways to improve the efficiency and accuracy with which the EHR system matched patients with their records, improving patient safety and saving clinicians significant amounts of time. Document how they consider the needs of doctors, nurses, and other clinicians in developing the product submitted for certification. Svetlana Z. Lowry et al., “NISTIR 7804: Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records,” National Institute of Standards and Technology (2012). There is no clear way to evaluate whether usability and safety challenges exist since selection of any order would be identified as a success. In September 2017, ONC modified its testing requirements to require health IT developers to state that they meet 30 certification criteria (approximately half of the total) instead of having them reviewed by an accredited testing lab.8 This reflected a major change in the approach to vendor certification. Each test case is provided on a template to support use by EHR developers, health care providers, or other stakeholders. Apply for a leadership position by submitting the required documentation by the deadline. To address these two challenges, The Pew Charitable Trusts, MedStar Health’s National Center for Human Factors in Healthcare, and the American Medical Association conducted a literature review and convened a multidisciplinary expert panel composed of physicians, nurses, pharmacists, EHR vendors, patients, and health information technology experts. Recommendations on how to advance usability and safety throughout the EHR software life cycle, which can be used as the foundation for a voluntary certification process for developers and EHR implementers. You can also engage patients in their healthcare. American Journal of Hospice and Palliative Medicine® 2017 35: 3, 532-541 Download Citation. Given the importance of detecting safety challenges early, test cases should focus on EHR interactions that have the potential for serious harm in addition to low-risk but frequent interactions that are unlikely to adversely affect the patient. You can send electronic health information, education materials, and visit summaries to your patients. But when a system is challenging to use or patient information is difficult for a clinician to find, safety risks could occur. However, there are no clear criteria for what constitutes a rigorous test scenario. Adherence to these recommendations by EHR developers and health care providers can reduce the likelihood of unintended patient harm from clinician use of this technology. A study in the journal Academic Medicine shows how a modified H&P can help collect more biopsychosocial information to better identify care barriers. 1. They were simple, did not reflect realistic clinical conditions, or included prescriptive instructions that may not be present in a clinical setting—making it more difficult to identify challenges that may arise when using the technology for actual care.28 Here is an example of a test case scenario that lacks rigor:29, “Looking at patient John Leeroy’s record, enter a new lab order for the patient.”. These criteria could provide a foundation for a voluntary certification program. While the criteria provide a framework for factors that can be included in voluntary certification programs, each institution creating such a program would have to tailor it to its specific goals and mission. Blackford Middleton et al., “Enhancing Patient Safety and Quality of Care by Improving the Usability of Electronic Health Record Systems: Recommendations From AMIA,” Journal of the American Medical Informatics Association 20, no. In 2016, ONC issued regulations giving it direct authority to enter health care facilities and review and test EHRs that posed serious risks to patients. 4 (2016): 1069–87. EHR design and configuration must: 1. We sought to fill these gaps through the development of a more comprehensive certification framework focused on the entire EHR life cycle that engages both developers and providers, and by developing test case criteria with examples based on prevalent usability and safety challenges. Encryption transforms electronic information i… This example is a basic scenario that tests the usability and safety of the allergy alerting function if allergies are entered in the EHR using the free-text option. Unleash innovation. This Association for the Advancement of Medical Instrumentation, “AAMI Launches Health IT Standards Initiative,” AAMI News, August 2015. The test cases include both inpatient and outpatient clinical settings. 2009, established the Medicare and Medicaid EHR Incentive Program—known as Meaningful With support from Infoway, each province and territory is creating a network of interoperable EHR solutions — one that links clinics, hospitals, pharmacies and other points of care. The clear scoring definition helps testers establish whether the system passed or failed the assessment. Clinical laboratories increasingly use electronic systems and standardized coding to record, store, and report laboratory results. In the news: Dementia and finance problems, CDC recommends first vaccine recipients, CDC shortens quarantine length, HHS allows telemedicine across state lines. EHR developers and health care providers use enhanced training methods, such as simulated clinical environments or expert trainers observing clinicians to provide direct feedback. The Electronic medical records were specifically identified as critical to quality improvement activities. instead of on paper. The use of both basic and advanced cases helps test the range of EHR capabilities and supports evaluation of a product early in design. Conduct formal usability testing for certain capabilities identified by the federal government. One of the main benefits of electronic health records is that all providers involved in a patient's care can access, enter, and share information.. Ready access to a comprehensive patient record will allow your organization to improve care coordination and communicate with patients. The scenarios allow for the observation of clinicians interacting with the EHR so that specific usability and safety challenges can be identified and addressed. EHRs make the transmission of health data faster than ever. It does not reflect the complexities of clinical care. As a basic scenario, this test case aims to represent a single aspect of the clinical workflow and identify whether the EHR supports the provider’s expectation that an allergy alert will be triggered if there are relevant known allergies. Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Offer product modularity and configurability 5. The use of both types of test cases during development and after implementation can help detect problems. All rights reserved. Download AMA Connect app for Basic cases can help evaluate single EHR features but should be used in combination with advanced ones throughout development and implementation. Learn how health information exchanges allow health care providers to securely share patient data electronically to support patient care across the country. Lots of physicians have already seen these benefits in their clinical practice management software system. Middleton et al., “Enhancing Patient Safety”; Maryam Zahabi, David B. Kaber, and Manida Swangnetr, “Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation,” Human Factors 57, no. EHR developers commit to review safety incidents with designated patient safety officers and groups of product users, and to share information across health care facilities. Don't miss our latest facts, findings, and survey results in The Rundown, Ways to Improve Electronic Health Record Safety, Science and Flexibility Improves Ocean Conservation in East Africa, State Budget Offices Promote Data-Driven Decision-Making, States Can Help Small Businesses Recover From the Pandemic, States Can Shorten Probation and Protect Public Safety. establishes technological requirements for EHRs, including their functions, how to record The background information provided in the testing and robustness sections enable nonclinical moderators to understand the nature of the test. Ibid. However, neither health facility was able to share either the identification of the problem or the solution with other systems. Criteria detailing what constitutes a rigorous safety test case and the creation of sample test case scenarios based on reported EHR safety challenges. Today however, new and ever-improving technologies allow for the health and care history of patients to now be tracked using electronic health records. With accessible electronic health records, physicians and healthcare providers are able to improve clinical research quality. The electronic health record (EHR) was introduced to improve how clinicians document patient information, contribute to medical research, and allow for medical records to be universally transferable. See daily video updates on how the AMA is fighting COVID-19 by discussing policymaking during the pandemic.