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(NISTIR 8042) Integrating Electronic Health Records into Clinical Workflow: An Application of Human Factors Modeling Methods to Specialty Care in ‘Obstetrics and Gynecology’ and ‘Ophthalmology’



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


In this report, a human factors workflow modeling tool, process mapping, was used to visualize and document insights and the end-user needs to improve EHR workflow for clinicians in two specialty outpatient care settings: 1) Obstetrics and Gynecology (Ob-Gyn) and 2) Ophthalmology. The findings identified clinical activities that required better integration with specialized software and devices, unique data fields, and more relevant and flexible workflows in EHR designs to support end users’ needs. Based on the insights generated during collegial discussions with physician Subject Matter Experts (SMEs) and two interdisciplinary team meetings with clinical and human factors experts, we created process map visualizations and identified opportunities for innovation. Targeted recommendations for EHR developers and Ob-Gyn and Ophthalmology centers to improve workflow integration with EHRs are proposed to improve quality of care, improve patient safety, and reduce medical-legal exposure. These recommendations provide a first step in understanding what the unique needs of two diverse specialty care areas are in order to better support workflow in outpatient care settings. Recommendations include better support for non-clinical aspects of workflow, such as scheduling and documentation, in order to facilitate high quality provider-patient interaction during a visit.
NIST Interagency/Internal Report (NISTIR) - 8042
Report Number


Electronic Health Record (EHR), User-Centered Design (UCD), Workflow, Workaround, Human Factors Workflow Modeling Tools, Process Map, Subject Matter Experts (SMEs), Obstetrics and Gynecology (Ob-Gyn), Opthalmology
Created February 10, 2015, Updated November 10, 2018