EMR Redesign for Pediatric Nurses
Reducing friction in clinical documentation
Overview
Pediatric nurses spend a significant portion of every shift documenting patient care. However, the existing electronic medical records require nurses to navigate inconsistent workflows, remember where documents are located, and manually track recurring tasks, which increase their cognitive load and reduce efficiency.
For my master's thesis, I redesigned one of the most frequently used workflows, ad hoc forms, to create a more intuitive, user-centered experience for pediatric nurses.
The Problem
Pediatric nurses complete documentation throughout every shift, yet the existing electronic medical record (EMR) made this process unnecessarily difficult. Nurses had to navigate long lists of forms, remember where documentation was located, and complete inconsistent workflows that increased cognitive load and reduced efficiency.
The Solution
I redesigned the ad hoc documentation workflow to make documentation easier to find, complete, and manage. The redesign introduced a searchable form library, standardized documentation layouts, automated reminders for recurring tasks, improved system feedback, and created a more intuitive workflow that reduced reliance on memory.
My Involvement
As part of my master's thesis, I led the project from research through prototype development. I conducted a literature review, surveyed 56 pediatric nurses, developed personas and a journey map, performed a usability review, translated research findings into design insights, redesigned the ad doc form workflow, created an interactive prototype, and evaluated the redesign with pediatric intensive care nurses.
Methods
Literature Review · Surveys · Personas · Journey Mapping · Workflow Analysis · Prototyping · Comparative Usability Reviews
My Role
UX researcher · UX designer
Team
UX Specialist · Two PICU Nurses · Three Thesis Advisors
Project Timeline
Literature Review & User Research → Usability Review → Design & Prototype → Comparative Usability Review
Challenge
For my master's thesis, I focused on redesigning one of the most frequently used and complex workflows in the EMR currently used by pediatric nurses at Children's Mercy.
A survey of 56 nurses identified ad hoc forms as one of the most frequently used EMR features and a significant source of usability challenges. My goal was to understand the barriers nurses experienced when completing documentation and redesign the workflow to reduce unnecessary cognitive load and better support their daily clinical tasks.
Research
Step 1: Literature Review
To better understand the challenges surrounding EMR usability, I reviewed existing research on clinician documentation workflows. The literature highlighted common issues including increased documentation burden, workflow interruptions, and the cognitive effort required to navigate complex systems. These findings guided my approach to evaluating the current EMR experience and identifying opportunities for improvement.
Step 2: Engage Nurses
To understand which areas of the EMR created the greatest challenges for pediatric nurses at Children’s Mercy (CM), I surveyed 56 direct care nurses at CM. Participants ranked the EMR features they used most frequently and found most difficult to complete.
The results identified ad hoc forms (nursing documentation) as one of the most complex workflows and one of the most frequently used feature in the EMR. Based on these findings, I focused the redesign on improving the ad hoc forms documentation experience.
The survey also collected demographic information to better understand the backgrounds and experience levels of participating nurses.
Current EMR Ad Hoc Forms - Nursing Form Folder
Current EMR - Non-Violent Restraint Form (Page 1)
Current EMR - Non-Violent Restraint 1 Form (Page 2)
Step 3: Develop Personas
To better understand the needs, challenges, and workflows of direct care nurses, I created a series of personas based on survey findings and clinical context. Each persona represented different levels of EMR experience, common documentation challenges, and opportunities for improvement.
For example, Martha represents an experienced nurse who has adapted to years of EMR changes. While she knows where information is located and has developed workarounds to complete daily tasks, inconsistent documentation workflows still create unnecessary effort.
Martha’s Problem Statement:
Martha has watched the EMR evolve. She knows where everything is in the current system, but has multiple workarounds to successfully complete her daily tasks. Although Martha is an EMR wizard, she still struggles to complete some forms, as each form layout is different.
Key Insight!
Healthcare professionals often develop workarounds to navigate gaps in complex systems. By creating more consistent documentation workflows and predictable interactions across ad hoc forms, the redesign could reduce unnecessary workarounds and better integrate into nurses' existing workflows.
Step 4: Workflow Analysis, Journey Mapping, & Usability Review
To better understand how nurses interact with the EMR during documentation, I created journey maps and conducted a usability review focused on common ad hoc forms documentation workflows. These activities helped identify where the current system created friction and increased cognitive effort for nurses.
Working with two pediatric intensive care unit (PICU) nurses, I developed three scenarios and four tasks representing common ad hoc documentation workflows:
Locating an admission form
Completing recurring non-violent restraint documentation
Documenting patient education
The journey maps highlighted several challenges within the current workflow:
Finding documentation required recall instead of recognition
Nurses had to remember where forms were located within the EMR because the system lacked search functionality. Important documentation was buried within folders, increasing the time and effort required to locate forms.Recurring documentation depended on memory
For non-violent restraint documentation, nurses were required to complete the same form every two hours until restraints were discontinued. Because the EMR did not provide reminders, nurses had to manually track when additional documentation was needed.Inconsistent workflows created additional effort
Documentation forms varied in layout and organization, requiring nurses to adjust their approach depending on the form they were completing.
Key insight!
The current EMR relied on nurses remembering where and when to document, rather than helping them recognize available actions and complete tasks at the appropriate time.
Usability Review Results
The two PICU nurses and I independently completed the three scenarios and four tasks within the current EMR, and evaluated our experience against a set of usability heuristics and best practices. The current EMR received an average usability score of 52.67/100 (Moderate Usability), confirming opportunities to improve navigation, consistency, and workflow support.
Journey Map
Current EMR Usability Review Process
Rating Scale for Usability Review
Design Decisions
Challenge
The existing EMR workflow relied heavily on memory and workarounds. Nurses had to remember where forms were located, when recurring documentation was due, and how to navigate inconsistent workflows.
Insight
The redesign needed to support nurses by making important actions easier to discover, reducing unnecessary mental effort, and providing better system feedback.
Design Decisions
Improve form discoverability
The existing EMR required nurses to navigate through multiple folders to locate documentation.I introduced a searchable form library to help nurses quickly find the appropriate documentation.
Support recurring documentation tasks
Nurses were required to complete certain forms repeatedly throughout their shift.I added reminders to reduce reliance on memory and support timely completion.
Create consistency across documentation workflows
The current EMR lacks consistent layouts and processes across documentation forms, requiring nurses to adjust their approach depending on the form they are completing.The redesign introduced more predictable layouts and interactions across forms, reducing the need for nurses to relearn each workflow.
Improve system feedback
The current EMR lacked clear system feedback, making it difficult for nurses to understand the results of their actions.I added confirmation messages and clearer error prevention to improve visibility of system status and help nurses confidently complete documentation tasks.
Step 5: Prototype & Evaluation
Based on the findings from the usability review, I redesigned the ad hoc form documentation workflow. The redesign focused on addressing the primary usability challenges identified during research: improving discoverability, reducing reliance on memory, and providing clearer system feedback.
Key design improvements included:
Redesigning the patient summary page
Adding a searchable form library
Creating automated reminders for recurring documentation tasks
Improving error prevention and messaging
Providing visual confirmation after user actions
After completing the prototype, the two PICU nurses and I conducted a second, independent usability review using the same scenarios, tasks, and evaluation criteria as the original assessment. The redesigned EMR received an average usability score of 86.33/100 (Good Usability), improving the average usability score by nearly 34 points and demonstrating the impact of applying user-centered design principles to complex clinical workflows.
Usability Review Results
Current EMR: 52.67/100 — Moderate usability, required nurses to remember locations, timing, and workflows
Redesigned EMR:
86.33/100 — Good usability, supported nurses through search, reminders, consistency, and feedback
The redesigned system improved the average usability score from 52.67 (Moderate) to 86.33 (Good).
Conclusion
This project demonstrated how user-centered design can improve complex clinical workflows. By combining research, usability evaluation, and iterative design, I redesigned an EMR documentation process that reduced reliance on memory, improved workflow support, and increased overall usability.
Future work would include incorporating additional nurse feedback, refining the prototype based on usability testing, and exploring opportunities to implement the redesigned workflow within the clinical environment.
EMR Redesign Concept - Color, Font, Layout
EMR Redesign - Patient Summary
EMR Redesign - Nursing Forms - Search
EMR Redesign - Non-Violent Restraints Form
View a demonstration of the redesigned EMR, showcasing improvements to the process of finding and completing the Non-Violent Restraint Form (Tasks 2 and 2.5).
Task 2: Complete the required documentation for restraining a non-violent patient.
Task 2.5: You realize it has been more than 2 hours since you first restrained your patient, you need to complete a second non-violent restraint form.
View a demonstration of the redesigned EMR, showcasing improvements to the process of finding the Admission Database Form (Task 1).
Task 1: Find the Admission Database Form
View a demonstration of the redesigned EMR, showcasing improvements to the process of documenting education (Tasks 3).
Task 3: Document the G-tube education you provided.