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Electronic Health Record Design Considerations in Responding to Incidences of Highly Infectious Diseases: Clinical Workflows and Exception Handling



Svetlana Z. Lowry, Mala Ramaiah, Emily S. Patterson, Latkany A. Paul, Debora Simmons, David Brick, Michael C. Gibbons


Adoption of Electronic Health Record systems in all care settings has become widespread. EHRs can support and revolutionize the way that public health is protected in the event of an outbreak of a highly infectious disease. In particular, EHRs can support continuity of care across transitions, such as treatment for Ebola. In this report, infectious disease experts provided insights about patient safety and workflow considerations that arose during their experiences treating patients suspected of having Ebola, and how these considerations related to poorly supported tasks when treating any highly infectious patient. These insights provide a first step in creating an effective infrastructure to better identify, diagnose, treat, and report of infectious diseases in the United States. The lessons from this effort might also have implications beyond the treatment of highly infectious diseases. A primary insight is that users need reliable and relevant EHR information, including a summary of relevant history and an easily interpretable view of when vaccinations were provided against the patient’s expected immunization schedule. In order to achieve this goal, there needs to be confidence that the correct patient’s record is open, that the information in the record is accurate, and that information that is used in graphical representations in structured fields is complete and integrates information from multiple sources, including data from other EHR systems. The EHR needs to be a reliable tool verified through standardized testing that optimizes clinical outcomes and public health awareness by giving the health care team comprehensive and trusted information that can be efficiently interpreted across role-based physical and cognitive workflow.
NIST Interagency/Internal Report (NISTIR) - 8095
Report Number


Electronic Health Records, Infectious Diseases, vaccination, Ebola, patient safety, workflow, standardization, insights, guidance.


Lowry, S. , Ramaiah, M. , Patterson, E. , Paul, L. , Simmons, D. , Brick, D. and C., M. (2015), Electronic Health Record Design Considerations in Responding to Incidences of Highly Infectious Diseases: Clinical Workflows and Exception Handling, NIST Interagency/Internal Report (NISTIR), National Institute of Standards and Technology, Gaithersburg, MD, [online], (Accessed June 16, 2024)


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Created December 10, 2015, Updated November 10, 2018