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Many Electronic Health Records (EHR) systems have structures that require complex navigation and work flows. The inevitable consequence is that providers are now burdened in delivering timely patient care.  A $17 billion British health-service information-technology upgrade was terminated after $9.9 billion in expenditures, because the program was ‘‘not fit to provide the modern information technology services” needed by the country’s healthcare system; the article further noted that information technology systems are sometimes designed without ‘‘enough input from doctors and nurses who [then] rebel against the product”.

Communication of what one provider considers important needs to be understood by other individuals involved in the care  of mutual patients. Recent articles suggest that the EHR should improve communication between nurse practitioner and primary care physicians. This problem of communication might be eased if the EHR display facilitated the digital triage of work flow, as in report sign-off/sign-out. By ‘‘signing off” we mean the acknowledgement of a result. By ‘‘signing out” we mean the transfer of the task of acknowledgement to someone else.

However, there are a number of barriers to improving EHR performance. Currently, fully deployed EHR systems are generally not

compatible with each other. At present no standard mechanism exists to test the structural re-design of fully deployed EHR systems. The serious concerns about potential compromise to patient data confidentiality further burden any effort at EHR redesign.

We determined as practitioners (JF, EA) the aspect where cur- rent EHR performance most lagged our current EHR need. We chose the development of a single screen display that could show all the data from a medical practice and highlight the critical data. Vital to optimal care delivery is the prompt acknowledgement of and response to critical reports. The notion of critical reports is  well established and is a feature of current EHR systems, including the EHR systems in this study. If a display could be developed that physically separates reports with critical results from those with non-critical results, the display could become the basis for a rational scheme for work triage.

Also, we structured the investigation to test if the provider always agreed with the EHR system-defined critical/non-critical designations. If providers frequently reassign results that the EHR designated critical as non-critical, and non-critical as critical, then the display design should have the capability, beyond that of acknowledging system-defined critical results, to allow the provider to set critical ranges and mine the patient data.

We wanted to create a standalone display system that relies only on an interface, agnostic to software language of EHR of report origin, to work easily with all existing EHR systems.

Finally, we decided that an initial off-line test of such a display system would provide important answers as to whether the effort to conduct a full-scale implementation of the display system  would be justified.

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