Design Principles in Health Information Technology

Electronic health record (EHR) systems are said to be the cornerstone of a modernized health service. They improve health care, allow for integrated information, and help prevent lost and duplicated records as well as occurrence of administrative errors. Studies have consistently shown, however, that introducing EHR systems is a complex task, with difficulties stemming from technical designs that fit poorly with the details of clinical work practices. Given the evolving role of EHRs and the importance of information design, the need exists for further exploration of EHRs with the purpose of advancing innovations in health IT with the potential for significant positive effects on clinical practice. This paper focuses on a subfield of EHR studies that is working to establish a foundation for applying information design principles to implementation of health information technology in primary care settings. Without loss of generality, the paper examines a specific attempt that includes documenting patterns of clinician information use and developing “use cases” and tools for evaluating EHR implementation. The paper proposes an alternative approach based on a new flow-based specification methodology. It is shown that the method can be applied uniformly at the conceptual requirements level and simultaneously at the user interface level. The new method seems to be a viable technique for expressing situations arising in clinical work practices.