NISTIR 7952

Toward a Shared Approach for Ensuring 

Patient Safety with Enhanced Workflow 

Design for Electronic Health Records

Summary of the Workshop

Svetlana Z. Lowry

Mala Ramaiah

A. Ant Ozok

Ayse P. Gurses

Michael C. Gibbons

David Brick

Emily S. Patterson

Vicki R. Lewis

Debora Simmons

 

 
NISTIR 7952

Toward a Shared Approach for Ensuring 

Patient Safety with Enhanced Workflow 

Design for Electronic Health Records

Summary of Workshop

 Svetlana Z. Lowry

Mala Ramaiah

Information Access Division

Information Technology Laboratory

A. Ant Ozok

University of Maryland Baltimore County

Baltimore, MD

Ayse P. Gurses

Johns Hopkins University School of Medicine

Baltimore, MD

Michael C. Gibbons

Johns Hopkins University

Baltimore, MD

David Brick

NYU Langone Medical Center 

New York, NY

Emily S. Patterson

Ohio State University

Columbus, OH

Vicki R. Lewis

MedStar National Center for Human Factors in Healthcare

Washington, DC

Debora Simmons

St. Luke’s Health System

Houston, TX

August 2013

U.S. Department of Commerce 

Penny Pritzker, Secretary

National Institute of Standards and Technology 

Patrick D. Gallagher, Under Secretary of Commerce for Standards and Technology and Director
ii

Table of Contents

Executive Summary...........................................................................................................iii

1 Overview ..................................................................................................................... 1

1.1 Introduction .......................................................................................................... 1

1.2 Background .......................................................................................................... 1

2 Structure of the Workshop........................................................................................... 3

2.1 Welcoming remarks by NIST .............................................................................. 3

2.2 Six short presentations ......................................................................................... 3

2.3 Open discussion.................................................................................................... 3

2.4 Next steps discussion with a short presentation................................................... 3

2.5 Review and summary........................................................................................... 3

3 Open Discussion.......................................................................................................... 4

3.1 Theme #1: Variations in workflow-related practice among developers and 

clinicians: ........................................................................................................................ 4

3.2 Theme #2: Standardization versus customization:............................................... 5

3.3 Theme #3: The dynamic nature of clinical workflows: ....................................... 6

3.4 Other Issues:......................................................................................................... 7

4 Next Steps: Borrowing from Examples of Other Industries That Successfully 

Integrated Safety into Design.............................................................................................. 9

5 Summary.................................................................................................................... 11

References......................................................................................................................... 12

Appendix A: Final Agenda ............................................................................................... 13

Appendix B: Acronyms Used in the Report ..................................................................... 15
iii

Executive Summary

On April 19, 2013, 47 participants met at the Johns Hopkins Armstrong Institute for 

Patient Safety and Quality, Baltimore, MD, for the National Institute of Standards and 

Technology (NIST)-sponsored full-day workshop titled EHR Usability and Patient Safety 

Roundtable: Supporting Patient Safety Through EHR Design. In addition to 

representatives from the host organizations, there were seventeen representatives from 

EHR systems developers who were invited through Electronic Health Record Association 

(EHRA). The remainder was clinical, human factors, information technology, and clinical 

safety experts. The goal of the workshop was to discuss and identify the common 

challenges and shared aspirations for designing EHRs that better support complex clinical 

workflows in order to improve usability, patient safety, and quality of care. 

EHRs have great potential to improve health care quality, enhance patient safety, 

streamline administrative processes, and more easily support population-based quality 

improvement and research. However, the integration of EHR systems into clinical 

workflows at fast rates has also introduced some unintended consequences and adverse 

events. [1,2,3,4]

Clinical workflows are complex and non-linear, often involving many different 

professionals, paraprofessionals, and stakeholders with associated interdependencies. The

EHR design is critical to support these complex interactions contained within. [5]

Workflow is also a multidimensional phenomenon that can be described differently based 

on the perspective taken (e.g., clinician versus patient). [6,7]

At the workshop, common ground on challenges and aspirations were identified by the 

representatives from EHR developers, EHR users, academics and government to improve 

patient safety, usability and human factors regarding workflows in the use of EHRs. 

Achieving these objectives for common ground is necessary to enhance safe and effective 

care for all patients and increase the rate of adoption of electronic health records in the 

United States. 

Common current and potential challenges in EHR usability and patient safety included: 

1) high variation in EHR-related workflow at the level of institutions, units within an 

institution, and the individual clinicians; 2) provider (user) requests/demands involving 

customization and its positive and negative effects on usability and patient safety; and 3) 

challenges in setting user requirements and executing usability and task analyses due to a 

lack of consensus among developers and providers concerning primary purposes of the 

EHR products. 

Shared aspirations among stakeholders for improving EHRs and patient safety included: 

1) modeling, understanding, and reducing the sources of variability; 2) providing 

guidance to end users regarding best practices for customization based on their specific 

workflows; 3) reducing uncertainty stemming from external requirements; and 4) 

improving EHRs to better match the different workflows of diverse users. There was 

interest within the group in adapting a voluntary collaborative model from other 
iv

industries, such as, for example, the automotive industry that was successful in 

integrating standardized safety features into design. 

The report that follows includes:

• Overview

• Structure of the workshop

• Open discussion

• Next steps

• Summary 

• 2 appendices: The workshop agenda and the acronyms used throughout the report

Keywords: Electronic Health Record (EHR), patient safety, usability, workflow, 

electronic health record design, health information technologies, human factors, medical 

informatics, workarounds 
v

DISCLAIMER

Certain commercial entities, equipment, or material may be identified in this document in 

order to describe a concept adequately. Such identification is not intended to imply 

recommendation or endorsement by the National Institute of Standards and Technology, 

nor is it intended to imply that these entities, materials, or equipment are necessarily the 

best available for the purpose.
1

1 Overview

1.1 Introduction

On April 19, 2013, 47 participants met at the Johns Hopkins Armstrong Institute for 

Patient Safety and Quality, Baltimore, MD, for the National Institute of Standards and 

Technology (NIST)-sponsored full-day workshop titled EHR Usability and Patient Safety

Roundtable: Supporting Patient Safety Through EHR Design. In addition to 

representatives from the host organizations, there were seventeen representatives from 

EHR systems developers who were invited through Electronic Health Record Association 

(EHRA). The remainder was clinical, human factors, information technology, and clinical 

safety experts. The goal of the workshop was to discuss and identify the common 

challenges and shared aspirations for designing EHRs that better support complex clinical 

workflows in order to improve usability, patient safety and quality of care. 

1.2 Background

EHRs have great potential to facilitate clinicians’ work, improve health care quality, 

enhance patient safety, streamline administrative processes, and more easily support 

population-based quality improvement and research. However, the integration of EHR 

systems into clinical workflows at fast rates has also introduced some potential 

unintended consequences. [1,2,3,4]. EHR workflows have to be designed to reflect 

clinical workflows and the end user needs. Not all tasks in a workflow involve 

electronics/computers (e.g., visual examination of patient by physician). Clinical 

workflows consist of a set of tasks grouped into processes and the set of people or 

resources needed to accomplish those tasks to achieve a specified goal. For example, 

there exists a link between EHR implementation and an increase in wait times for patients 

in an emergency department, suggesting challenges with EHR workflow integration in a 

dynamic clinical context. [5]

If EHRs are to provide optimum user performance and enhance patient safety, they must 

be designed based on the realities of clinical workflow in which they will be used. [6,9]

For these reasons, the Usability Task Force convened by the American Medical 

Informatics Association (AMIA) Board published a position paper in Journal of the 

American Medical Informatics Association (JAMIA). This position paper included 

recommendations for NIST, in collaboration with the Office of the National Coordinator 

of Health Information Technology (ONC), to “perform formal usability assessments on 

patient-safety sensitive EHR functionalities.” [10]

The discussions at the workshop were aimed at determining issues among the 

stakeholders on common challenges and shared aspirations to support more usable, more 

efficient, and “safer and customized” EHR systems to support clinical workflows. This 

report summarizes the main discussion points at this meeting and the suggested necessary 

future steps to achieve safer and more effective care with the meaningful use of EHRs.
2

Clinical workflows are complex and non-linear, often involving many different 

professionals, paraprofessionals and stakeholders with associated interdependencies. The 

EHR design is critical to support the complex interactions contained within. [5]

Workflow is also a multidimensional phenomenon that can be described differently based 

on the perspective taken (clinician vs. patient). [6,7] Moreover, well-established common 

workflow features to guide the developers in the design of the EHRs do not currently 

exist. [11]
3

2 Structure of the Workshop

The workshop is summarized in four main sections: welcome remarks, short talks, open

discussion, and next steps. Please refer to Appendix A: Agenda for details of the 

workshop presentations. The presentations of the day are available at the NIST Usability 

website http://www.nist.gov/healthcare/usability/ehr-usability-and-patient-safetyroundtable.cfm The structure of the day was as follows:

2.1 Welcoming remarks by NIST

2.2 Six short presentations

As part of the morning and early afternoon sessions, there were several short 

presentations divided into three panels. The panel topics were:

• Patient Safety: Past, Present, and Future

• The ONC Perspective on Patient Safety and Usability

• NIST, EHRs & Patient Safety

Each panel session ended with a short question and answer session.

2.3 Open discussion

Two general discussions were held as part of the workshop for a total of approximately 

two and a half hours. The discussions allowed EHR developers, hosts and other experts to 

share opinions and information on the definition of EHR workflow, perceived and actual 

best practices, common challenges, shared aspirations, and potential and current solutions 

on making EHRs safer for patients and more usable for clinicians.

From the discussions, three themes with common challenges and shared aspirations for 

improving workflow design of EHRs were identified with the common consensus 

revolving around EHR features that may potentially impact patient safety. This is 

summarized in Section 4.

2.4 Next steps discussion with a short presentation

The final discussion of the day was led by the MedStar National Center for Human 

Factors in Healthcare representative. This section summarizes one of the examples for the 

best practices from the auto industry, and describes the common aspirations of the HIT 

community.

2.5 Review and summary

The workshop review and summary was wrapped up by NIST.
4

3 Open Discussion

During the discussion sessions, three important themes clearly emerged, along with 

several major issues and challenges.

3.1 Theme #1: Variations in workflow-related practice among developers 

and clinicians: 

a) Variability in design provides opportunity for innovation and enhanced efficiency. 

However, when core functionality is implemented inconsistently, the resulting 

unpredictability causes uncertainty for the user. 

This can be observed in radically different user interfaces and interactivity levels 

(levels of text-based vs. direct input interaction, for example) for EHR 

applications with similar functionality, levels of training offered to users by the 

developers for their products, etc. As a result of these multiple factors there is

inconsistency in EHR design for common clinical workflows. Frequently, 

developers are applying anecdotally driven or determined from non-evidencebased decisions and that may result in a fragmented approach to human factors 

and usability concerns taken by different companies, especially in relation to their 

workflow support.

One potential approach to this variation is to impose a culture of simplicity, which 

can be difficult to achieve due to the fact that clinical workflows are complex, 

non-linear, and involve many stakeholders with varying goals and skill levels. An 

alternative potential solution is to have discussions on variability of workflows 

and methods for bringing the best practices to patient safety in these dynamic and 

unpredictable variations in the environment. EHR designs with strong patient 

safety emphasis and clearly defined user requirements can help developers 

overcome the related design and implementation challenges.

b) The variability among EHR developers may also occur in the context of testing. 

Generating and standardizing a list of EHR functionalities with explanation of 

terms for testing can lead to more confident and productive information 

exchanges.

c) Given the complexities of clinical workflows and the amount of effort needed to 

identify potential variability across organizations and users, no one single

organization can identify all sources of variability. Instead, each organization, 

including EHR developers, should work in collaboration to understand the 

sources and underlying factors of variability. Systematic methods and central 

repositories that store and update workplace-induced design requirements (so that 

each individual developer does not need to “reinvent the wheel” every time) and 

collaboration for patient safety can be part of the solution. Each EHR developer 
5

can then use this information as a guide to produce designs with necessary 

flexibility and defined level of customization to compensate for these factors.

d) A related challenge is the fact that technologies in EHR are used by diverse users, 

in various settings with different clinical roles and a variety of specialties. Thus, it 

is difficult to compensate for all of the different users’ needs and expectations

within one system. With many key players in clinical workflows, user needs, 

requirements and expectations from Health Information Technology (HIT)

components can be conflicting and/or confounding. Taking workflow-related 

factors carefully into consideration during EHR design, as well as integrating safe 

customization whenever possible, are indicated as potential solutions in producing 

systems with the smallest number of conflicts.

e) In relation to the items covering variability, a plan for the long run, rather than 

quick fixes to issues, is needed. Long-term solutions, built on evidence-based 

research and defined “usefulness and usability principles” have the potential to 

prevent harms. Also, by embracing the user experience best practices and the 

user-centered design process, agencies save money in the long-term and increase 

productivity and efficiency with usable systems. [12]

f) There is variation in the levels of understanding of workflow among/within 

hospitals as well as among caregivers. Workflows can be very mature formal 

processes in hospitals, but they might not be well-established or formally 

documented across the many functions they interact with (such as writing a 

prescription). Even with well-established workflows, it may be difficult to 

translate the EHR functions properly into the workflows. Users may find out that 

things are missing, but only after they migrate to a new system. For example, 

acute care institutions can sometimes be described as having micro cultures – that 

is each “unit” may have a different culture and norm on their workflows and the 

role of EHRs within the workflows.

g) Unlike in other industries, HIT users have a wide variety of clinical and technical 

backgrounds. An immediate solution to this challenge is difficult to produce, 

except for possibly providing safe customization in design, as indicated earlier.

h) The next logical question is how to ensure patient safety by standardization and 

when to allow additional customization given the high variability in clinical 

workflows.

3.2 Theme #2: Standardization versus customization:

a) Standardization can be applied to the design of EHR, implementation, employee

training and many other areas. However, workflows are highly complex even 

within the same hospital, and sometimes within the same unit. Standardization is 

therefore difficult for the varying needs of clinical workflows. Customization is 

also a problematic issue. Providers would like to have it, as tailoring systems to 
6

user needs can result in productivity gains and improved levels of satisfaction. 

Yet it is counter-to standardization, and can be excessively expensive to do for 

developers, with user needs varying across the board. Some developers, therefore,

do not support customization of their EHR products. Safety risks could be a direct 

or indirect result of customization as well. EHR customization and configuration 

is one of the 9 high-risk areas that relate to patient safety issues that can arise 

from the use of the EHR and proactive assessment of risks and vulnerabilities can 

help address potential EHR-related safety hazards before harm occurs. [13]

b) EHR developers indicated that it is difficult to know and decide where to 

standardize versus where to customize. Developers’ desire to design efficient 

EHR products can conflict with providers’ desire to have more control over EHR 

designs and functional elements. One suggestion is that systems can be optionally 

customizable, and/or customizable in some of their features. This kind of 

approach can be cost-effective while giving some providers what they want, and 

can have varying levels of feasibility based on the workflow complexity levels of 

the providers and other factors such as user motivations and knowledge to 

customize the system.

c) Similarly, there may be a certain level of guidance necessary to be given to 

developers on the set of functions their EHRs should perform. The overall set of 

functions that an EHR should contain is just as critical as the usability of the 

system while performing its functions.

d) One can argue that there is inadequate standardization in healthcare in general, 

and variations exist between and within hospitals, as well as between caregivers. 

e) On the other hand, customization could be potentially unsafe, and it is challenging 

to have a design process where both customization and safety are at very high 

levels. It will take a concerted effort on the part of developers and providers to 

determine how to balance safety factors and customization demands. It may have 

to be strictly defined what Graphic User Interface (GUI) components and 

functions can be customized by the users or providers and what customization 

should be restricted. Further research is necessary to determine what features 

should be customizable to support safe customization and flexibility.

3.3 Theme #3: The dynamic nature of clinical workflows:

a) Clinical workflows change over time. Designing systems that can compensate for 

changing workflows is difficult and it can therefore be suggested that developers 

build long-term relationships with providers to better understand the needs and 

potential changes over time, designing accordingly.

b) EHR systems should be reactive to challenges and changes rather than proactive. 

When workflows change, expand, or get combined, time is needed for the 
7

corresponding designs to catch up. EHR designs take time to compensate for 

these changes and challenges, and in a lot of cases do not compensate at all.

3.4 Other Issues:

a) Trust issues and cultural resistance to change are other major factors that may 

make EHR design and implementation difficult and cumbersome. User trust can 

be gained over long periods of time, and cultural changes can happen with longterm developer-user relationships and collaborations.

b) The HIT community should work more closely with medical representatives, such 

as doctors and nurses, to better define user requirements and to help developers in

achieving positive end user experience. However, what metrics can be used for 

success concerning these types of collaborations may need to be discussed and 

clarified more.

c) The Web component opens the use of EHR onto a larger platform. It can include 

home access of medical records by physicians and nurses. Access, security,

usability and other issues need to be considered for such large-base environments, 

which is difficult for the broad variety of medical information and varying goals 

behind accessing the information.

Table 1 summarizes the challenges identified in the discussion with specific examples 

and shared aspirations for moving forward. The challenges identified in the discussion, in 

general, include: 1) high variation in workflow at the level of institutions, units within an 

institution, and the individual clinicians; 2) demands for customization by providers that 

have the potential to negatively impact usability and patient safety; and 3) complications 

in setting user requirements and executing task analyses due to a lack of consensus 

among developers and providers concerning the primary objectives of EHRs. 

The shared aspirations were 1) modeling and reducing the sources of variability; 2) 

providing guidance to end users regarding best practices for customization to local 

workflows; and 3) reducing uncertainty regarding external requirements.
8

Table 1. Major issues and challenges discussed in the workshop and the corresponding 

shared aspirations

Challenges Examples of potential negative impact on workflow and 

patient safety

Shared Aspirations

Variations in 

workflowrelated practice 

among 

developers and 

clinicians

Inconsistent use of applications; 

Reduced levels of efficiency and effectiveness of processes; 

Financial, and sometimes life-related losses;

Anecdotal, non-evidence- based solutions resulting in 

negative user experience;

Lack of unity in understanding the different user groups; 

and 

Lack of trust in the system.

Understanding the 

sources of variability;

Standardized functions;

Plans aimed at long-term 

usage of EHRs;

Sharing responsibility 

and accountability

Standardization 

vs. 

customization

Lack of safety assurance in customization;

Complex workflows not being compatible with 

standardization techniques;

Customization being counter-standardization and resulting 

in trade-offs;

Inadequate standardization in health IT;

Presenting 

customizations that do 

not negatively impact 

safety and achieve 

optimal efficiency and

effectiveness;

Collaboration between 

developers and providers 

for more tailored designs

The dynamic 

nature of 

workflows

One-size-does-not-fit-all phenomenon;

Highly variable users and demographics;

Web-based workflows changing rapidly and often being not 

well understood.

Better understanding of 

end-user needs by 

defining specific user 

requirements and 

accommodating changes 

in workflows over time;
9

4 Next Steps: Borrowing from Examples of Other Industries That 

Successfully Integrated Safety into Design

In 1965 and 1966, public pressure grew in the United States to increase vehicle safety. In 

1966, Congress created the United States (US) Department of Transportation. The 

National Highway Traffic Safety Administration (NHTSA) was officially established in 

1970. The mission of NHTSA is to “save lives, prevent injuries and reduce economic 

costs due to road traffic crashes..." Some examples of its involvement in safety are noted 

in the use of the center high mounted safety lamp, electronic stability control on vehicles 

and the new car assessment program. In the early 1990's, in an era of exploding 

technological capability during which the potential for collision avoidance technology 

was changing the landscape for vehicle safety, the thought was that a consortium of auto 

manufacturers could be formed to conduct collaborative research to determine the 

appropriate metrics and measures for evaluating the safety and efficacy of collision 

avoidance technology. The manufacturers later thought they could leverage their data in a 

way that they not only believed in, but were prepared to support so that they could get 

vehicles to the market faster. The Crash Avoidance Metrics Partnership (CAMP) was 

formed in 1995 to accelerate the implementation of crash avoidance countermeasures in 

passenger cars to improve traffic safety. [14]

Once the consortium came into place, both CAMP and NHTSA recognized the potential 

of working together. By forming collaborations that included academic and independent 

evaluators, NHTSA and CAMP could drive the science that determined the metrics and 

measures for vehicle safety. Recognizing this cooperation as the fastest and most costeffective approach to improving safety with initiatives like connected vehicle research. 

Today NHTSA funds as much as 65 percent of research to support new safety 

technologies. For auto manufacturers, they gain the non-automotive partners they need to 

develop cutting-edge technology. NHTSA and the Federal Highway Administration 

support the infrastructure requirements of collision avoidance technology that is required 

for new technologies such as intersection collision avoidance, once they know that the 

critical mass of automotive manufacturers are on target for a new safety technology 

release. With immense safety consequences of poor design, the safety technology would 

take many more years to get introduced, resulting in lost lives and lost economic benefit.

CAMP is merely one example of consortia in the automotive industry. Other industries, 

such as aviation, have an even longer and richer history of federal/industry cooperation to 

satisfy common and independent motivations. 

The usability and usefulness of HIT are important and necessary measures to move the 

potential and safety of Health IT forward. The lessons from other industries would 

indicate that more opportunity exists to create sweeping innovations in Health IT through 

consortia between Health IT vendors, federal agencies, and healthcare entities. The 

history of consortia in other industries indicates that even greater potential exists by 

widening the net to include federal and healthcare partners. One may look at consortia 

developed in other industries as a model for collaboration that benefits all parties 

involved.
10

Attendees expressed interest in adapting a voluntary collaborative model from other 

industries, such as the automotive industry, to prioritize and address patient safety 

concerns with developers and academic representatives. The common desire for the 

participants is to have common consensus on safety features, and to do this by holding 

voluntary meetings to harmonize the EHR industry in making a positive and lasting 

impact on patient safety.
11

5 Summary

Usability and human factors approaches in supporting EHR clinical workflows have been 

identified as critical factors for patient safety and other quality of care metrics. 

Application of the EHR workflows and their use by multiple users and teams with 

varying technologies has had mixed results to date. Clinical workflows are unique due to 

the high stakes they involve, the high diversity of users, the specific processes and 

technologies, and the number of stakeholders involved (e.g., multiple EHR developers or 

decision makers on purchasing). In this meeting, EHR developers, government 

representatives, users and academicians identified common ground on challenges and 

aspirations to improve patient safety, usability, human factors, and customized workflows 

with the use of electronic health records. Achieving these objectives is necessary to 

provide safe and effective care to all patients and increase the rate of meaningful adoption 

of EHRs in the United States. 
12

References

1.Karsh BT, Weinger MB, Abbott PA, Wears RL. Health information technology: 

fallacies and sober realities. J Am Med Inform Assoc 2010;17:617-623.

2.Ash JS, Sittig DF, Dykstra R, Campbell E, Guappone K. The unintended 

consequences of computerized provider order entry: findings from a mixed 

methods exploration. Int J Med Inform 2009;78 Suppl 1:S69-S76.

3.Aarts J, Doorewaard H, Berg M. Understanding implementation: the case of a 

computerized physician order entry system in a large Dutch university medical 

center. J Am Med Inform Assoc 2004;11:207-216.

4.Institute of Medicine. Health IT and Patient Safety: Building Safer Systems for 

Better Care. 2012. Washington, DC, The National Academies Press. 

5.Cain C, Haque S. Organizational Workflow and Its Impact on Work Quality. In: 

RG Hughes, ed. Patient Safety and Quality: An Evidence-Based Handbook for 

Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008.

6.Carayon P, Karsh B-T, Cartmill R. Incorporating Health Information Technology 

into Workflow Redesign--Summary Report. AHRQ Publication No. 10-0098-EF. 

2010. Rockville, MD, Agency for Healthcare Research and Quality. 

7.Ozkaynak M, Brennan PF, Hanauer DA et al. Patient-centered care requires a 

patient-oriented workflow model. Journal of the American Medical Informatics 

Association 2013;20:e14-e16.

8.Mohan MK, Bishop RO, Mallows JL. Effect of an electronic medical record 

information system on emergency department performance. Med J Aust

2013;198:201-204.

9.Gurses AP, Xiao Y, Hu P. User-designed information tools to support 

communication and care coordination in a trauma hospital. J Biomed Inform

2009;42:667-677.

10. Middleton, Blackford, et al. "Enhancing patient safety and quality of care by 

improving the usability of electronic health record systems: recommendations 

from AMIA. Journal of the American Medical Informatics Association 2013.

11. Karsh B. Clinical practice improvement and redesign: how change in workflow 

can be supported by clinical decision support. Agency for Healthcare Research 

and Quality, US Department of Health and Human Services Publication 2009.

12. http://www.usability.gov/what-and-why/user-centered-government.html

13. Singh H, Ash JS, Sittig DF. Safety Assurance Factors for Electronic Health 

Record Resilience (SAFER): study protocol. BMC Medical Informatics and 

Decision Making 2013, 13:46.

14. Zhulman M, Deering RK. Third Annual Report of the Crash Avoidance Metrics 

Partnership, April 2003 - March 2004; DOT HS 809 83. NHTSA: Washington, 

DC. January 2005.
13

Appendix A: Final Agenda

EHR Usability & Patient Safety Roundtable

“Supporting Patient Safety through EHR Design” 

April 19, 2013 - 8:30am – 4:30pm

The Johns Hopkins Armstrong Institute for Patient Safety and Quality

Room A, 4th Floor, Constellation Building, 750 E. Pratt Street,

Baltimore, MD

Agenda

7:30- 8:30 Breakfast

8:30 – 8:45 Welcome and Objectives for the Day

Lana Lowry, PhD - National Institute of Standards and Technology

8:45 – 9:30 Patient Safety Past, Present and Future

Peter Pronovost, MD, PhD – Armstrong Institute

9:30 – 10:00 The ONC Perspective on Patient Safety and Usability 

Jacob Reider, MD - Director, Office of the Chief Medical Officer, ONC 

David Hunt, MD, FACS - Medical Director, Health IT Adoption and 

Patient Safety, ONC 

10:00-10:15 Break

10:15-11:15 NIST, EHRs & Patient Safety

Provider Challenges – David Brick, MD - Village Cardiology

Patient Safety – EHR Usability Framework and EUP – Emily Patterson, PhD

OSU

Clinical Perspective and NIST Research – Dean Calcagni, MD – NIST

11:15 – 12:00 Discussion

Emily Patterson, PhD – Ohio State University Medical Center

12:00 – 1:00 Working Lunch

12:30 – 1:30 NIST, EHRs & Patient Safety 

Emerging Provider Challenges, EHR Workflows – David Brick, MD –

Village Cardiology

EHR-Workflow Integration- Ayse Gurses, PhD – Armstrong Institute

Gaining Deeper Insight into EHR Usability to Support a National Standard –

Michael Wiklund, PhD - UL, LLC
14

1:30 – 2:30 Discussion 

Emily Patterson, PhD – OSU, Ayse Gurses, PhD – Armstrong Institute

2:30 -2:45 Break

2:45 – 3:45 Next Steps Discussion

Vicki Lewis, PhD – National Center for Human Factors Engineering in

Healthcare “How one industry has driven best practice and the potential for 

healthcare”

3:45-4:15 Meeting Review & Summary 

Lana Lowry, PhD - National Institute of Standards and Technology

4:15-4:30 Closing Remarks

Armstrong Institute, ONC
15

Appendix B: Acronyms Used in the Report

AMIA American Medical Informatics Association

CAMP Crash Avoidance Metrics Partnership

EHR Electronic Health Records

GUI Graphic User Interface

HIT Health Information Technology

IT Information Technology

NHTSA The National Highway Traffic Safety Administration 

NIST The National Institute of Standards and Technology

ONC Office of the National Coordinator of Health Information Technology 

US United States