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Guiding principles for EHR design: A 10-point checklist

  • Jeanne Armstrong, M.D.
  • 03/22/2016

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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About the author

Jeanne Armstrong, M.D., is director of solutions management for Allscripts TouchWorks® EHR and is a practicing physician at Hendricks Regional Health Immediate Care (Avon, Indiana, U.S.A.).With more than a decade of experience in healthcare IT, Dr. Armstrong has in-depth knowledge in EHR training, system configuration, content development and change management. Dr. Armstrong is board certified in Family Medicine and Clinical Informatics and completed her family medicine residency at St. Vincent Hospital in Indianapolis, Indiana. At St Vincent, she designed and facilitated a physician training program and support process for a community-based academic medical center with four (eventually five) residency programs, overhauled workflow and content to create a paperless immediate care, developed system content for multiple specialties, and helped facilitate an electronic data conversion between competing EHR systems. Dr. Armstrong earned a Certificate in Clinical Informatics, Clinician Leader from Indiana University, earned her medical degree from Indiana University School of Medicine, and holds a bachelor’s degree from Franklin College of Indiana.

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