AUTHOR BIOGRAPHIES
Zoe Pruitt, MA, (Zoe.M.Pruitt@medstar.net) is a human factors scientist at the MedStar Health National Center for Human Factors in Healthcare.
Jessica Howe, MA, is the associate director of operations at the MedStar Health National Center for Human Factors in Healthcare.
Lucy Bocknek,
MS, OTR/L, is a human factors and safety scientist at the MedStar Health National Center for Human Factors in Healthcare.
Arianna Milicia,
BS, is a senior research associ-ate at the MedStar Health National Center for Human Factors in Healthcare.
Patricia Spaar,
MS, RN, is a senior clinical safety and research specialist at the MedStar Health National Center for Human Factors in Healthcare.
Seth Krevat, MD, is the senior medical director at the MedStar Health National Center for Human Factors in Healthcare and an assis-tant professor at Georgetown University School of Medicine.
Raj Ratwani, PhD, is the director of the MedStar Health National Center for Human Factors in Healthcare, vice president of scientific affairs at the MedStar Health Research Institute, and an associate professor at Georgetown University School of Medicine.
Abstract
Background: Despite their prevalence, poorly designed electronic health records (EHRs) are common, and research shows poor design consequences include clini-cian burnout, diagnostic error, and even patient harm. One of the major difficul-ties of EHR design is the visual display of information, which aims to present infor-mation in an easily digestible form for the user. High-risk industries like aviation, automotive, and nuclear have guidelines for visual displays based on human factors principles for optimized design.
Purpose: In this study, we reviewed the visual display guidelines from three high-risk industries—automotive, aviation, nuclear—for their applicability to EHR design and safety.
Methods: Human factors experts extracted guidelines related to visual displays from automotive, aviation, and nuclear human factors guideline documents. Human fac-tors experts and a clinical expert excluded guidelines irrelevant to EHR. Human factors experts used a modified reflexive thematic analysis to group guidelines into meaningful topics. Disagreements were discussed until a consensus was reached.
Results: A total of 449 guidelines were extracted from the industry documents, and 283 (63.0%) were deemed relevant to EHRs. By industry, 12 of 44 (27.3%) auto-motive industry guidelines were relevant, 43 of 115 (37.4%) aviation industry guide-lines were relevant, and 228 of 290 (78.6%) nuclear industry guidelines were relevant. Guidelines were grouped into six categories: alphanumeric; color, brightness, contrast, and luminance; comprehension; design characteristics; symbols, pictograms, and icons; and tables, figures, charts, and lists.
Conclusion: Our analysis identified visual display guidelines organized around six topics from the automotive, aviation, and nuclear industries to inform EHR design. Multiple stakeholders, including EHR vendors, healthcare facilities, and policymakers, can apply these guidelines to design new EHRs and optimize EHRs already in use.
Keywords
visual display, health IT, electronic health record, human factors, patient safety
