When designing the content of your electronic health record, you have lots to think about. I've just written about data format decisions with some examples.  Databases also permit you to place rule-based controls around Clinician use of options and fields in the EMR. These tools protect data integrity by preventing unauthorized input and protecting content from modification. They help ensure that Clinicians are capturing the same sorts of information and that you are getting the information your organization must have. An effective controls strategy enforces desired content while minimizing the inclusion of inappropriate and unnecessary data. The type and extent of controls also implement your organization's goals and policies.

 

In other words, they are a very useful set of functions in your design toolkit. Now, what do I mean by Controls?  Here is a list of some with examples:

·    Define access to options and fields as for input or "read only"– Denying input access to finalized forms protects the integrity of the content and of accountability. Denying access to (disabling) a time field that auto-fills with the current time prevents fudging the time vital signs were recorded.

·    Make fields required or optional for filing. Required fields ensure completeness and consistency. Optional fields invite the addition of relevant information in consistent formats.

·   Use event logic e.g., "If this response is selected, then this will happen." If the required item “Pain Present Y/N” is clicked “No,” then the initially disabled fields for Intensity and Location remain disabled, preventing extraneous data. If  “Yes” is selected, then the Intensity and Location fields become enabled and required, ensuring compliance with organizational policies about assessing pain in all patients.

 

Hopefully I am giving you the idea. This document shows more examples of Controls with Avatar screen shots.

 

But a caution is in order. Controls must be deployed judiciously. As in so many situations, the path lies in establishing a balance, this time between control and flexibility. All organizations have legitimate data needs. Explaining these needs to Clinicians should be part of the implementation process. At the same time, if content is too tightly controlled e.g. all or most fields are required, Clinicians will feel overly constrained with little room for expression of their professional expertise. They will resent the software for turning them into robots. Nobody wants that.