Using Human-Centered Design Theory for EHR's

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Having timely access to large amounts of patient information has the potential to revolutionize our health care system, but many clinicians using Electronic Health Record(s) EHRs are finding the new systems overly complex with inefficient interfaces that require increased cognitive and manual task performance [1,2]. Human-Centered Design (HCD) values recognition-based memory and perceptual judgments over pure recall, which is an element of distributed cognition theory regarding the human brain’s natural tendency to distribute cognitive activities across the internal mind, as well as, external artifacts within one’s environment [1,3].


Human-Centered Computing (HCC) merges diverse backgrounds and skill sets to design mixed-initiative human computer systems that consider human characteristics such as culture and relationships as a component of the human-computer interaction [2]. An algorithm design would include:

  • human abilities and limitations
  • social and cultural awareness and
  • adaptability across individuals and specific situations [2].

Cognitive Task Analysis (CTA) is used to analyze the physical and cognitive procedures that make up a human task [1]. It can be applied in a non-laboratory work environment to study a person’s interaction with the EHR while performing individual tasks that make up one work flow – such as a nurse updating a patient’s medication chart.

Work-Centered Design (WCD) seeks to bring the importance of human workflows in line with the user interface by first identifying a work unit that will be separately defined and then evaluated through an algorithm to determine how well the person and the computer work together to produce each unit of work [4,5].


Today's health care environment is highly dependent on humans interacting with computers. As clinicians we are tasked with the job of seeing more patients per day while also coordinating care for the patient across multidisciplinary care teams. In order to effectively offer an integrated care record for this increased patient load, it will be necessary for clinicians to work through a distributed design that allows for a reduction of unnecessary information based on clinical role and current stage within the known workflow. HCD seeks to accomplish this by placing as much importance on the human's interaction and response to the machine as it does to the machine's response to the human.

Usability has been shown through qualitative studies to improve various aspects.

Related articles


  1. Saitwal H, Feng X, Walji M, Patel V, Zhang J. Assessing performance of an Electronic Health Record (EHR) using cognitive task analysis. International Journal of Medical Informatics 2010;79:501-506.
  2. Jaimes A, Gatica-Perez D, Sebe N, Huang TS. Human-centered computing:Toward a human revolution. Computer 2007;4(5):30-34.
  3. Gong Y, Zhang J. A human-centered design and evaluation framework for information search. In: Proceeding of AMIA;2005;Washington, DC:281-285.
  4. Nahm M, Zhang J. Operationalization of the UFuRT methodology for usability analysis in the clinical research data management domain. Journal of Biomedical Informatics 2009; 42(2):327-333.
  5. Butler KA, Zhang J, Esposito C, Bahrami A, Hebron R, Kieras D. Work-centered design: A case study of a mixed-initiative scheduler. In:Proceeding of CHI;2007;San Jose, CA:747-756.

Submitted by Seana Zagar, MSW