An electronic health record (EHR) is part of the work system through which nurses obtain information, record care, communicate, and follow up. Evaluating it means looking beyond whether a screen opens: the question is whether information reaches the right person in time to support the next clinical action.
The Office of the National Coordinator for Health Information Technology's SAFER guides address EHR safety across patient identification, communication, decision support, system management, and downtime. Their recommendations are safety assessment guidance, rather than a guarantee of regulatory compliance.
Follow the work across screens
A useful nursing workflow review starts with one patient-care activity, such as an admission or transfer, and traces its beginning and end. Identify who gathers the information, who checks it, where it is recorded, who receives it, and how unfinished work becomes visible. Include the steps outside the EHR: a telephone conversation, a bedside assessment, and a discussion with a caregiver can all change what needs to happen next.
AHRQ's workflow assessment toolkit emphasizes that health IT changes both clinical and administrative work. For a local review, observe several users rather than assuming that one experienced nurse's sequence represents every shift. Ask staff to explain confusing labels, repeated entries, and places where the record does not reflect how care is actually delivered.
Distinguish recording from communication
A note can contain accurate information without establishing that another clinician received a time-sensitive request. A practical workflow therefore needs an identified recipient and an escalation route for urgent concerns. The SAFER clinician communication guide addresses reliable messaging and responsibility for follow-up.
Similarly, an automatically populated field needs a visible source and time. A value copied from a previous encounter should not look like a new observation. When reviewing a screen, ask what a nurse could reasonably infer from its labels, and whether that inference matches the underlying data.
Illustrative workflow review
Suppose a unit's admission process asks the nurse to enter a patient's preferred contact in two places. One feeds the discharge instructions; the other feeds the team directory. During an illustrative redesign exercise, the team traces both destinations before removing either field. It discovers that a single entry could serve both purposes only after the interface is changed and tested.
This example does not establish that duplicate fields are always unnecessary. It shows why deleting a visible task without checking its downstream use can create another problem.
Decide whether a change helped
Before changing the build, define the problem and a feasible measure. Examples for a local evaluation include time to find a current care plan, contradictory entries, or unfinished transfer tasks. Pair staff experience with observation and safety reports. Faster charting alone does not establish safer care.
After release, ask whether users can complete the intended task under ordinary working conditions, including interruptions and handoffs. Keep an owner for unresolved defects and a route for urgent safety concerns. An EHR workflow remains a clinical responsibility after the implementation team leaves.
To test what happens across roles, start by mapping the clinical workflow.
Related
Nursing Documentation Templates
Sources
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AHRQ: Workflow Assessment for Health IT Toolkit (accessed 2026-09-17).
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SAFER: Clinician Communication (accessed 2026-09-17).
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SAFER: System Management (accessed 2026-09-17).