Preventing Your EHR from Working Against You, Part III: Creating a Test Script

Once the workflow analysis for a task has been completed, it can be used to create a test script for EHR evaluation.  There is no standard process for creating a test script.  The method described here is one that I used for the 1917 Clinic EHR project.   Since there is no single correct way of doing this, experiment as freely as you like.   Tests scripts are equally useful if you are moving from paper to an EHR or from one EHR to another. For either scenario, the information in your test script will contain much of the same information.  Here is a test script created using the prescription workflow example from the last post. You may use it as a guide when creating your own.

Workflow Steps
Your test script will have four types of information: workflow steps, action/information required at each step, time required at each step, and EHR evaluation criteria.  Begin by copying the workflow steps from the analysis document to a table with four columns. Make sure that there are sufficient rows in the table to account for all workflow steps.

Specific Actions/Information Requirements
Specific actions/information requirements comprise the second column in the table.   This column contains brief descriptions of the actions performed and/or the information required to complete the workflow step.   “Review of demographic information” is an example of both an action to be performed and a description of the information needed (demographic) at a particular step. The information in this column should have been captured as part of the information requirements review segment of the workflow analysis.  This column should be as detailed as possible–review it for completeness.

The third table column records the amount of time that the step requires based on your measurements (with paper or different EHR). The table should contain time-interval data for each step as well as the total time for the entire task (Steps 1-7).

EHR Review Criteria
The final column in the script addresses specific EHR review criteria.   EHR review criteria should be selected according to their ability to help in analyzing usability. Therefore, issues such as screen readability, the number of clicks required to perform a task, or the number of screens viewed in order to complete a task are covered in this column. The sample test script contains generic criteria that you may customize for your situation.  For example, the “open demographics screen” item is a generic criterion related to viewing patient information.    In your test script, you might expand on this criterion by adding the following:

  1. Number of clicks required to open the demographics screen.
  2. Does the demographics screen show age and/or date of birth?
  3. Is the primary insurer included with main demographics data?

The EHR criteria column is the best location to note important EHR behaviors. The criterion “Can lab data be reviewed, by type, order date, and abnormals?” captures information concerning the degree to which an EHR allows providers to adjust lab data display options.

Focus on creating criteria that are specific to your practice.  Before finalizing a test script, try it out on at least one EHR product.  (You may gain access to an EHR for testing purposes at a hospital or vendor training site, vendor demo, or perhaps a regional extension center.  Also, consider using an open source EHR to try out your script).   By doing this, you will discover any remaining gaps in your criteria.   Once you have taken it for a few test spins, it will be ready for prime time.  In cases where more than one person is evaluating an EHR, adding a final column for capturing numerical scores can be helpful for ranking products.

If you have followed all three posts, you should have enough information to do a personal workflow analysis and create a test script for important clinical tasks.   I hope that you have found this series useful.  I would love to hear if the steps outlined help you to select an EHR.

Test script example (Link)

Preventing Your EHR from Working Against You, Part I: EHR Workflow and Personal Work Habits

Preventing Your EHR from Working Against You, Part II: Personal Workflow Analysis

See Electronic Health Records, Second Edition (Chapters 16, 17, 22) for additional information concerning workflow analysis, EHR evaluation, and test scripts.


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