Pediatric Informatics: Computer Applications in Child Health (Health ...

242 M.G. Leu et al.
are to be effective in reducing error, human factors and clinical workflows must be
considered when designing interfaces. Embedded calculators with minimal human
interaction provide the fewest errors (e.g., automatic computation and display of
weight, height, and body mass index percentiles when a child steps on a scale in
the pediatrician’s office).
17.3.3.2 Tools to Access, Create, and Update Information
EHRs make information available in a legible and accessible form, but this alone
is not sufficient to improve the quality of care. 34 Users (patients, providers, and
office staff) must also be able to interact with and control access to electronic health
information. Important considerations include:
Data entry.
Some users find computer data entry to be difficult or cumbersome.
Transitioning from handwritten to online notes may require adequate user interface
design; or support for alternate forms of data entry such as audio-recording
and transcription. Changes to user interfaces (such as larger, simpler forms) may
be needed for users with visual impairment. 35
Another important consideration with regards to electronic data entry is comprehensiveness.
Just as creating standardized forms for well child visits encourages
uniform practice, easily updatable electronic templates or checklists can
support the consistent practice of high quality, evidence-based care.
Data retrieval and review.
Currently, the way patient information is displayed
may vary greatly between EHR systems. There are no standards for retrieval
and visualization functions between EHR systems in the U.S. (although the U.K.
National Health Service is deploying a Common User Interface for use across
all EHRs36 ). Using a system with a well designed user interface which supports
appropriate clinical workflows is particularly important in the fast-paced,
high-volume ambulatory care setting. The user model for the system, including
design considerations such as layout of information, intuitiveness, specific language
used, and level of detail required for interaction may all dictate whether
the system improves provider productivity, or the implementation fails.
Properly designed electronic health record systems provide a longitudinal
(over time) view of a patient, which allows providers to provide better care.
Tests can be reviewed instead of being reordered, and providers can take historical
information such as allergies or treatment failures into consideration.
However, common trend views, such as growth charts, may not be readily available
in all products. It is important to know which displays and reports that are
available and which need to be constructed when considering the purchase of an
EHR system.
Data security.
Tools and interfaces must guarantee information assurance (confidentiality,
integrity and availability) and adhere to HIPAA privacy and security
rules. 37 In addition to technical approaches (e.g., secure interfaces, time-limited
user authentication), practices must have policies in place that define appropriate
staff use of information, penalties for violations, and protocols for reporting