Graphic shortcomings: EHRs display lab test data poorly

An analysis of eight popular EHRs found none of their user interfaces had optimal graphing displays of laboratory test results.

Lead researcher Dean F. Sittig, PhD, a professor in the School of Biomedical Informatics at the University of Texas Health Science Center in Houston, and colleagues concluded that the results suggested EHR-generated graphs do not meet evidence-based criteria to improve laboratory data comprehension.

The eight EHRs were the Allscripts Enterprise v10, Cerner Millenium Powerchart 2012, eClinicalWorks v10, Epic Hyperspace v2012, Glassomics v1, Meditech v5.64, Partners Longitudinal Medical Record v9.3 and VA Computerized Patient Record System v2014. Six of the eight EHRs were certified by the Office of the National Coordinator for Health Information Technology.

The researchers tested the EHRs, read the available literature, spoke with experts and developed 11 objective criteria for optimal graphs. The 11 criteria were a visible patient ID, title that described the graph’s contents, x-axis label, x-axis scale, x-axis values, y-axis label, y-axis scale, y-axis values, reference range, data details and a legend explaining different colors or shapes used to mark the data points.

None of the EHRs met all 11 criteria, although one met 10 of the 11. The researchers mentioned that none of the EHRs had a graph with y-axis labels that displayed the name of the measured variable and the units of measure. They also wrote that one EHR graphed results in reverse chronological order, while another wrongly depicted the visual slope perception between data points.

With EHRs becoming more popular, the researchers wrote that providers should review the components of their EHR graphs and understand what the data points represent. Suboptimal displays could affect clinical decision-making even though an FDA report from April 2014 proposed no additional oversight of EHRs or products with health management IT functionality were needed.

“We recommend policymakers ensure clear and accurate visual display of laboratory data through more stringent Office of the National Coordinator for Health Information Technology authorized testing and certification bodies EHR certification testing criteria,” the researchers wrote. “These criteria should be based on the best available scientific evidence from the literature and expert opinion, when no published evidence exists.”

The results were published online March 18 in the Journal of the American Medical Informatics Association. The Agency for Healthcare Research and Quality funded the study.