Health Information Systems and Electronic Health Records
Health information systems and EHRs tests core EHR functions, architecture, interfaces, usability, downtime, and lifecycle. Questions ask you to connect a function to its safety purpose and to recognize where a system design choice creates new risk.
Core functions and architecture
- Core functions include CPOE, eMAR and BCMA, clinical documentation, results review, order sets, scheduling, referral management, patient portal, and HIE access.
- Closed-loop medication management runs order, pharmacist verification, dispensing, administration, documentation, and monitoring. Barcode scanning at the bedside is a key control; exceptions require a documented reason.
- Interfaces commonly use HL7 v2 messages for ADT, orders, and results; an interface engine monitors queues and errors.
Usability and safety
- Human factors review addresses cognitive load, screen design, alarm and alert fatigue, and error recovery.
- Usability testing with representative users, and safety review such as SAFER, can reveal risks before go-live.
- Downtime planning covers planned and unplanned events, read-only access, paper forms, and post-downtime reconciliation.
Worked example
A unit reports frequent BCMA scan failures and nurse overrides. Reasoning: the fix is not simply retraining. The team checks wristband print quality, barcode symbology, scanner placement, and exception workflow. It measures scan compliance and wrong-patient events before and after. If failures persist, it tests a different wristband stock or scanner, then monitors.
Traps
Treating the EHR as the complete legal record; no downtime plan; assuming more alerts mean safer care; skipping post-go-live optimization and safety huddles.