How Consistency in EHR Design Can Contribute to Patient Safety

By Emily Richmond and Tammy Coutts, Chair and Vice Chair, EHRA Clinician Experience Workgroup


Anyone who switches frequently between a Mac and a PC knows the pain of inconsistency. The OK and Cancel buttons are in different places, the menus are in different locations, and there are even differences in the way you close a screen or program. These inconsistencies, while seemingly trivial, can contribute to a user’s “cognitive load,” which is the thing that makes you feel fuzzy and slow when you’re navigating a screen that doesn’t fit your mental model.

As system designers, electronic health record (EHR) developers operate in the same way as the designers of other systems–they work closely with users to understand their needs and the context of their use, and they strive to create designs that are straightforward, simple to understand, and a joy to use. However, despite this shared dedication to delivering a high quality product, EHR products from different companies don’t always present solutions to those problems in the same way. The result could be that systems that were designed in isolation to reduce cognitive load might end up contributing to it when a user must use multiple platforms to complete their daily tasks.

While many people put up with the Mac/PC differences on a daily basis, it’s important to pay attention to resolving these problems in the healthcare setting since clinicians who switch between different EHR systems can face similar cognitive difficulties–with potentially serious consequences. One way to prevent or reduce these challenges is to strive for more consistency across EHR systems. Consistency, especially in areas that could contribute to a patient safety event, can be achieved through what are called “design patterns,” which are recipes for best practice design that anyone can follow.

Design Patterns for Patient Safety  is a new guide created through a collaborative effort of EHRA member companies’ software designers and engineers, human factors experts, clinicians, and others with experience in the development and use of EHRs in a variety of healthcare organizations. The guide highlights many of the ways that consistency across health IT platforms can aid clinicians with things like accurately interpreting test results, or prescribing the right medication at the right dose.

Screenshot-2017-11-9 ehra-design-patterns-for-safety pdf

Created to provide recommendations and bring awareness to the value of design consistencies in high risk patient safety areas, Design Patterns for Patient Safety is a simple reference guide for EHR system designers and developers, focusing on best practices to reduce patient safety risk and reduce cognitive load for clinician end-users. The guide collects best practices from both within and outside the industry and presents them using short, simple examples and suggestions.

Screenshot-2017-11-10 ehra-design-patterns-for-safety pdf(1)For a designer of a new system or someone looking to revamp a legacy screen, this guide makes following best practices easy.

As we collaborated on Design Patterns for Patient Safety, we learned that while some guidelines were obvious, others were more contentious. Therefore, our goal is to make this a living document, continually expanding into new areas and updating with the newest guidance.

We welcome your feedback, thoughts, and suggestions.

Leave a comment


  1. Alex Jones

     /  October 8, 2020

    While consistency in design is vital, it is often limited to industry-standard terms and principles. For top EHR software, there are other essential features that make them a good choice for a practice or hospital. For example, customization and optimization for different specialties are far more important features that practices look for when choosing an EHR vendor.


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