Electronic Health Record (EHR) systems can help to improve patient safety by reducing common errors, but they can also introduce new safety risks associated with the technology itself. The application of Human Factor (HF) methods in an EHR implementation project is critical to identify usability issues early and optimize the build to ensure safety, efficiency, and alignment with clinical workflows. Despite the benefits, inclusion of HF evaluations can have time and resource costs which must be accounted for in the overall project plans and timelines. Based on our experiences with a large-scale EHR implementation project, this article outlines recommendations on how to incorporate HF evaluation methods into EHR design. Over the 7-year roll-out, the HF team had the opportunity to engage with over 400 clinical end users in 30 usability evaluations across the EHR project, which yielded over 2,000 recommendations for improvement to address usability issues.
Get full access to this article
View all access options for this article.
References
1.
ChapanisA. To communicate the human factors message, you have to know what the message is and how to communicate it. Bullet Human Factors Soc. 1991;34(11):1-4.
2.
WickensCDLeeJDLuiYGorden-BeckerSE. An Introduction to Human Factors Engineering. 2nd ed.London: Pearson Education; 2004.
3.
CafazzoJASt-CyrO. From discovery to design: the evolution of human factors in healthcare. Healthc Q. 2012;15 Spec No:24-29. doi:10.12927/hcq.2012.22845
4.
CatchpoleKBowiePFouquetSRiveraJHignettS. Frontiers in human factors: embedding specialists in multi-disciplinary efforts to improve healthcare. Int J Qual Health Care. 2021;33:13-18. doi:10.1093/intqhc/mzaa108
UsluAStausbergJ. Value of the electronic medical record for hospital care: update from the literature. J Med Internet Res. 2021;23(12):e26323. doi:10.2196/26323
7.
ParkSMarquardJAustinRRPieczkiewiczDJantrapornRDelaneyCW. A systematic review of nurses’ perceptions of electronic health record usability based on the human factor goals of satisfaction, performance, and safety. Comput Inform Nurs. 2024;42(3):168-175. doi:10.1097/CIN.0000000000001084
8.
VirginioLARicarteILM. Identification of patient safety risks associated with electronic health records: a software quality perspective. Stud Health Technol Inf. 2015;216:55-59. doi:10.3233/978-1-61499-564-7-55
9.
FennellyOCunninghamCGroganL, et al.Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inf. 2020;144:104281. doi:10.1016/j.ijmedinf.2020.104281
10.
KhairatSColemanCNewlinT, et al.A mixed-methods evaluation framework for electronic health records usability studies. J Biomed Inf. 2019;94:103175. doi:10.1016/j.jbi.2019.103175
11.
GagnonMPShawNSicotteC, et al.Users’ perspectives of barriers and facilitators to implementing EHR in Canada: a study protocol. Implement Sci. 2009;4(1):20-28. doi:10.1186/1748-5908-4-20
12.
HoweJLAdamsKTHettingerAZRatwaniRM. Electronic health record usability issues and potential contribution to patient harm. JAMA, J Am Med Assoc. 2018;319(12):1276-1278. doi:10.1001/jama.2018.1171
RatwaniRMSavageEWillA, et al.A usability and safety analysis of electronic health records: a multi-center study. J Am Med Inf Assoc. 2018;25(9):1197-1201. doi:10.1093/jamia/ocy088
15.
CarayonPWetterneckTBCartmillR, et al.Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations. J Patient Saf. 2021;17(5):E429-E439. doi:10.1097/PTS.0000000000000358
16.
BoryckiEKushnirukA. Identifying and preventing technology-induced error using simulations: application of usability engineering techniques. Healthc Q. 2005;8 Spec No:99-105. doi:10.12927/hcq.17673
17.
CarvalhoCJBoryckiEMKushnirukA. Ensuring the safety of health information systems: using heuristics for patient safety. Healthc Q. 2009;12 Spec No Patient:49-54. doi:10.12927/hcq.2009.20966
18.
KushnirukAWBoryckiEM. Human factors in healthcare IT: management considerations and trends. Healthc Manag Forum. 2023;36(2):72-78. doi:10.1177/08404704221139219
19.
DaviesJMCairdJKChisholmSErgonomicsC. Trying before buying: human factors evaluations of new medical technology. In Anca, JM Jr, ed. Multimodal Safety Management and Human Factors: Crossing the Borders of Medical, Aviation, Road and Rail Industries. London: CRC Press; 2007:315-323. https://doi.org/10.1201/9781315596297
NamshirinPIbeyALamsdaleA. Applying a multidisciplinary approach to the selection, evaluation, and acquisition of smart infusion pumps. J Med Biol Eng. 2011;31(2):93-98. doi:10.5405/jmbe.839
GordonSCragerJHowryC, et al.Best practice recommendations: user acceptance testing for systems designed to collect clinical outcome assessment data electronically. Ther Innov Regul Sci. 2022;56(3):442-453. doi:10.1007/s43441-021-00363-z
24.
DumasJSRedishJC. A Practical Guide to Usability Testing. Revised ed.Bristol: Intellect Books; 1999.
DumasJSSalzmanMC. Usability assessment methods. Rev Human Factors Ergon. 2006;2(1):109-140. doi:10.1177/1557234x0600200105
27.
DubéMHronJDBiesbroekS, et al.Human factors and systems simulation methods to optimize peri-operative EHR design and implementation. Adv Simul. 2025;10(1):23-212. doi:10.1186/s41077-025-00349-z
28.
DubéMShultzJBarnesSPascalBKabaA. Goals, recommendations, and the how-to strategies for developing and facilitating patient safety and system integration simulations. Health Environ Res Des J. 2020;13(1):94-105. doi:10.1177/1937586719846586
29.
BiasR. The pluralistic usability walkthrough: coordinated empathies. In: NielsenJMackR, eds. Usability Inspection Methods. Hoboken, NJ: John Wiley and Sons; 1994:63-76.
30.
CooperLBaberC. Focus groups. In: StantonNHedgeABrookhuisKSalasEHendrickH, eds. Handbook of Human Factors and Ergonomics Methods. Boca Raton, FL: CRC Press; 2005:321-327.
StantonNBaberCYoungM. Observation. In: StantonNHedgeABrookhuisKSalasEHendrickH, eds. Handbook of Human Factors and Ergonomics Methods. Boca Raton, FL: CRC Press; 2005:281-287.
33.
GearyTM. Contextual inquiry. In: Tham JCK, ed. Keywords in Design Thinking: A Lexical Primer for Technical Communicators & Designers. The WAC Clearinghouse and University Press of Colorado; 2022:63-66. doi:10.37514/tpc-b.2022.1725.2.10.
34.
CatchpoleKNeyensDMAbernathyJAllisonDJosephAReevesST. Framework for direct observation of performance and safety in healthcare. BMJ Qual Saf. 2017;26(12):1015-1021. doi:10.1136/bmjqs-2016-006407
