NIST report focuses on better integrating EHRs

The National Institute of Standards and Technology (NIST) has issued a report that includes recommendations for developers and outpatient care centers to better integrate EHRs into clinical workflow.

Targeted recommendations for improving workflow integration with EHRs are proposed to increase efficiency, allow for better eye contact between the physician and patient, improve physician’s information workflow and reduce alert fatigue. In addition, the recommendations cover scenarios such as supporting tasks accomplished over multiple interactions with an EHR by multiple users, for example, a nurse practitioner drafting medication orders that are verified and completed by a physician. 

NIST used "two human factors workflow modeling tools, process mapping and goal-means decomposition" to collect, visualize and document insights and end-user needs to improve EHR workflow for clinicians in outpatient care settings. The report identifies clinical activities that "require more relevant and flexible workflows in EHR designs to support end users’ needs" and provides process map visualizations and a goal-means decomposition diagram.

The purpose of the report is to "provide a first step in moving from a billing-centered perspective (i.e., focusing on ensuring maximum and timely reimbursement) to a clinician-centered perspective where the EHR design supports clinical cognitive work" and to "point the way towards a 'patient visit management system,' which incorporates broader notions of supporting workload management, supporting the flexible flow of patients and tasks and preventing common workarounds."