Enhancing Patient Safety And Quality Of Care By Improving The Usability Of Electronic Health Record Systems: Recommendations From AMIA

Abstract
In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.

Introduction
US healthcare delivery is in the midst of a profound transformation which results, at least in part, from Federal public policy efforts to encourage the adoption and use of health information technology (health IT). For example, HITECH regulations1 within the American Recovery and Reinvestment Act2 incentivize health IT use,3 ,4 and are changing the practice of medicine and clinical care delivery in both beneficial3 ,5 ,6 and untoward ways.7 Increased adoption of electronic health record (EHR) systems has been accompanied by heightened recognition of issues related to ‘goodness of fit’ in the user-friendliness of EHR systems.8 Some EHR users lament that health IT seems designed more for clinical transactions than for clinical care, and may not be easy to use in some care settings.9 ,10 In addition, many EHR systems require extensive training and lack standard user interfaces so that clinicians who work in multiple care settings using disparate technologies may struggle with the differences in interface design, with adverse impact on patient safety.11 [...]