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Comparative Study
. 2015 Jul;22(4):900-4.
doi: 10.1093/jamia/ocv013. Epub 2015 Mar 18.

Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems

Dean F Sittig  1 , Daniel R Murphy  2 , Michael W Smith  2 , Elise Russo  2 , Adam Wright  3 , Hardeep Singh  2
Affiliations
Comparative Study

Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems

Dean F Sittig et al. J Am Med Inform Assoc. 2015 Jul.

Abstract

Accurate display and interpretation of clinical laboratory test results is essential for safe and effective diagnosis and treatment. In an attempt to ascertain how well current electronic health records (EHRs) facilitated these processes, we evaluated the graphical displays of laboratory test results in eight EHRs using objective criteria for optimal graphs based on literature and expert opinion. None of the EHRs met all 11 criteria; the magnitude of deficiency ranged from one EHR meeting 10 of 11 criteria to three EHRs meeting only 5 of 11 criteria. One criterion (i.e., the EHR has a graph with y-axis labels that display both the name of the measured variable and the units of measure) was absent from all EHRs. One EHR system graphed results in reverse chronological order. One EHR system plotted data collected at unequally-spaced points in time using equally-spaced data points, which had the effect of erroneously depicting the visual slope perception between data points. This deficiency could have a significant, negative impact on patient safety. Only two EHR systems allowed users to see, hover-over, or click on a data point to see the precise values of the x-y coordinates. Our study suggests that many current EHR-generated graphs do not meet evidence-based criteria aimed at improving laboratory data comprehension.

Keywords: diagnostic tests; electronic health records; national health policy; user computer interface.

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Figures

Figure 1:
Figure 1:
A stylized graph used to illustrate the criteria we developed and used to evaluate the various EHRs.
Figure 2.
Figure 2.
A screen shot from the Veteran’s Affairs Computerized Patient Record System showing a graph of a patient’s hemoglobin A1c levels over time.
Figure 3:
Figure 3:
A screen shot from Partners Healthcare System’s Office of the National Coordinator for Health Information Technology authorized testing and certification bodies certified Longitudinal Medical Record system. Note that the x-axis displays results in reverse chronological order.
See this image and copyright information in PMC

References

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