When More Data Isn't Better: How Human Factors Engineering Simplifies Pathology Reporting in EHRs

Electronic Health Records (EHRs) are an important interface between healthcare clinics and laboratories, a hub for communicating diagnostic information to clinicians and patients alike. Yet, for a variety of reasons, EHR interfaces are not always user-friendly, which can lead to misinterpretation, delayed diagnosis, and even unnecessary patient anxiety. To address these challenges, a recent study published in the American Journal of Clinical Pathology (AJCP) highlights how applying Human Factors Engineering (HFE) principles significantly improves the display and clarity of pathology reports. 

What is HFE? 

HFE is a multidisciplinary science that focuses on aligning systems with human needs and methods by simplifying design elements and complex data. Ethan Larsen, PhD, senior human factors engineer in the Center for Healthcare Quality and Analytics at Children's Hospital of Philadelphia (CHOP), explains, “It is our goal to understand the entire system at play—the people, tasks, tools, technology, and environments—to make the work fit the people rather than forcing people to conform to the work.” 

Simplifying pathology results in the EHR is important because they affect different users in unique ways, whether that’s clinicians who need to make rapid decisions or anxious patients checking results in their patient portals. 

HFE removes guesswork from data 

Traditional EHR interfaces don’t always reflect the needs of clinicians or patients. “Helping translate what is oftentimes built from the subject matter expertise of a laboratory and a pathologist but is conveyed to a bedside clinician may not be the same information that both parties want,” Dr. Ethan Larsen says. 

Moira P. Larsen, MD, MBA, physician executive director of Pathology at MedStar Health, says these communication discrepancies are what makes HFE so potentially useful in EHRs; it takes the guesswork out of “the right thing to do or the right way to interpret the data.” 

She adds, “You want to make it hard for people to make mistakes. The goal is to convey the information so that the clinician gets the right data on the right patient at the right time and can appropriately interpret it and make clinical care decisions.” 

The AJCP study specifically addressed challenges in interpreting preliminary pathology reports, particularly complex test sequences like HIV screening, which can confuse clinicians. Dr. Moira Larsen explains, "In the paper, we specifically pointed out the addition of flagging to help make it clear that there is other work happening following the preliminary result, that this isn't the final result.” 

Without these clear visual cues, clinicians can interpret a preliminary positive result as definitive, which could lead to inaccurate clinical decisions and can cause unnecessary patient anxiety. 

To mitigate these issues, the researchers applied HFE-based design changes that improved visual cues, such as highlighting preliminary results with clear, intuitive flagging mechanisms. 

Improving on how patients read results 

Mohammad Jalloul, MD, a radiology research scholar at Children’s Hospital of Philadelphia, not only worked closely on the study, he brings the perspective of a patient-facing physician and describes the benefits: "Through these interventions, implementing human factors principles into something like HIV reporting or urine toxicology, you can minimize the time the doctor needs to interpret these results, decreasing the likelihood of misinterpretation and enhancing patient care." 

Since the CARES Act made it easy for patients to access their own results before having a clinician explain them, Dr. Ethan Larsen points out that HFE design can also improve the way patients read their own results. 

Dr. Moira Larsen adds, “If you don't have any indication or know what the HIV screening test is and that screening test comes back positive, that's a whole lot of discomfort, angst, and unnecessary anxiety that you really don't want to cause people.” 

Successful rollout of HFE at CHOP 

The successful results at CHOP and MedStar Health have been so effective, Dr. Moira Larsen shares, that MedStar has since expanded these principles beyond HIV reporting: “We've applied it to Lyme disease, malaria interpretation, and everywhere you have complex series of tests or algorithms that require multiple steps to guide clinicians to the correct final answer.” 

Despite these benefits, HFE principles have not been widely implemented across healthcare institutions. Reasons range from vendor limitations in EHR software to the availability of in-house human factors expertise. 

Dr. Ethan Larsen acknowledges, “At CHOP, we are fortunate—there are six people holding the title human factors engineer. But we run up against the issue of how to make it work within the confines of what we're allowed to adjust.” 

Like many who work directly with EHRs in healthcare settings, he’s an advocate for vendors to put in more time consulting with clinicians during the design phase, rather than leaving hospitals to retrofit their EHR interfaces. 

Relevant data at the right time 

Dr. Moira Larsen also pointed out that pathologists are important clinical collaborators: “We can't just throw data out there and assume that the right thing's going to happen. We need to work with our patient-facing colleagues to assess what they truly need and what's the best way to provide that to them.” 

Dr. Jalloul encourages other institutions to critically assess their own workflows and consider an HFE approach. “They can follow our recommendations or build their own to make their workflow easier and positively impact patient care.” 

Ultimately, applying HFE principles to EHR pathology reports could bring significant quality improvement to patient safety and diagnostic accuracy. 

“Simply put, in the lab sometimes more data is just more data,” Dr. Moira Larsen says. “What's needed is presenting relevant data at the right time, in the easiest and fastest way to understand.”