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Guiding principles for EHR design: A 10-point checklist

As one of the clinical architects of Allscripts TouchWorks® EHR, I work hand in hand with our functional architect, product owners and user-centered design (UCD) experts. We work as a team on new designs to make sure we’re using best practices to improve usability.

We developed the following guiding principles as a checklist to help us better focus our product development on what users need:


1. Let users do their work when and where they discover it needs to be done.

Reduce the amount of unnecessary clicks to complete a workflow. Design navigation and workspaces to enable users to perform a wide variety of tasks, while tailoring them for the most frequently performed actions. Where possible, free cognitive resources with automation.

2. Acknowledge chaos.

Consider users who perform tasks in chaotic work environments, where interruptions are expected. Make it easy for users to resume suspended tasks. Expecting chaos has driven feature improvements in TouchWorks EHR 15.1.

3. Every action needs a clear recovery path.

Mistakes happen. Users must have an option to correct mistakes. Error warnings and notifications must clearly explain what is wrong and give the user a simple solution to retract and fix it.

4. When everything is important, nothing is.

Highlight information users will most likely need for the task at hand. Only use color with other cues to provide emphasis. Build displays to adapt to the available screen size.

5. Don’t make a user do something to know if it was worth doing.

Always provide the user with enough status information to decide what they need to do or where they need to go next. Status information must be trustworthy (perceived by users as up to date and accurate).

6. Track it so you can improve it.

Record how people use our product, making it possible to include actual usage data in enhancement design decisions.

7. Balance personalization options with best practices in usability.

While it makes sense to tailor the software to fit the user, each individual’s preference may not optimize usability. Enable configuration of the system, but place limits in line with usability best practices.

8. If a feature can’t be set up and maintained it can’t be used.

If the admin cannot configure and maintain the feature, it may never get “turned on” and the user will never get a chance to use it.

9. Reduce the configuration burden.

Don’t give every possible configuration option, but enable only when necessary to reflect a business rule. Consider the cost in set up, maintenance, testing and how many users need those options.

10. Make interactions consistent.

Users should be able to predict the behavior they are going to experience, once they learn the patterns of the system.

We created this checklist to enable continuous improvement. It’s based on real-world experience over the long evolution of electronic health records (EHRs). We apply it consistently to our development efforts so we support how users want to work and help them achieve their goals.

Better usability is key for EHR adoption, use and patient safety. To learn more about our company’s commitment to best practices in UCD, download a free white paper here

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