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(NISTIR 7865) A Human Factors Guide to Enhance EHR Usability of Critical User Interactions when Supporting Pediatric Patient Care



Svetlana Z. Lowry, Matthew T. Quinn, Mala Ramaiah, David Brick, Emily S. Patterson, Jiajie Zhang, Patricia Abbott, Michael C. Gibbons


Adoption of electronic health record (EHR) systems in hospitals and physician practices is accelerating. Usability of EHRs has been identified as an important factor impacting patient safety and recommendations for improvement have been provided. Pediatric patients have unique characteristics that translate into unique EHR usability challenges. It is not surprising then that the adoption of EHRs by pediatric care providers has lagged behind adoption for adult care providers. In this document, we highlight important user interactions that are especially salient for pediatric care and hence to the EHR user-centered design process. These interactions and associated usability recommendations were identified by consensus during a series of teleconferences with experts representing the disciplines of pediatrics, human factors engineering, usability, and informatics. In addition, extensive peer review was provided by experts in pediatric informatics, emergency medicine, neonatology, pediatrics, human factors engineering, usability engineering, and software development and implementation. This report details recommendations to enhance EHR usability when supporting pediatric patient care and also identifies promising areas for EHR innovation. Finally, we illustrate unique pediatric considerations in the context of representative clinical scenarios which may be helpful for formative user-centered design approaches and summative usability evaluations.
NIST Interagency/Internal Report (NISTIR) - 7865
Report Number


Pediatric patients, pediatric care providers, critical user interactions, user-centered design, EHR usability


Lowry, S. , Quinn, M. , Ramaiah, M. , Brick, D. , Patterson, E. , , J. , , P. and C., M. (2012), (NISTIR 7865) A Human Factors Guide to Enhance EHR Usability of Critical User Interactions when Supporting Pediatric Patient Care, NIST Interagency/Internal Report (NISTIR), National Institute of Standards and Technology, Gaithersburg, MD, [online], (Accessed May 29, 2024)


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Created June 28, 2012, Updated November 10, 2018