About Tandem EHR

This project is funded by an R01 grant from the Agency for Healthcare Research and Quality (#1R01HS022505-01A1).

Our multidisciplinary team includes industrial and systems engineers, primary care physicians, and research staff with expertise in human factors and analysis of cognitive work.

“[It’s] Helpful to see all the information I need on one page without needing to search through the patient’s chart; [it] saves a lot of time.”


We designed the components of Tandem EHR by analyzing the clinician’s and team’s cognitive needs. This is a unique approach.

close up of EHR design
snapshot of Care plan section in prototype

"[It's] Helpful to see all the information I need on one page without needing to search through the patient's chart; [it] saves a lot of time."

What is Cognitive Work?

Patient care requires the clinician and team have Situation Awareness (SA). This is an awareness of all elements of the current situation, an understanding of their significance, and the ability to project into the future. The cognitive work of the team enables the establishment of SA, as well as other elements of care.

Tandem EHR was specifically designed to support the cognitive needs of both PCPs and their teams using SA-oriented design techniques. Tandem EHR supports the cognitive needs of PCPs and their teams and has a strong potential to facilitate the provision of high quality, more efficient patient care, unlike current EHRs. Specifically, teams can work together more effectively to provide patient care.


close-up of EHR prototype

EHRs must support cognitive work of individuals and teams

Our Tandem EHR prototype is designed for use by PCPs and their teams. It includes 16 pages of the front end of a patient chart with a care plan-based design and additional functionalities to coordinate schedules, tasks, and other information across the team and provide resource access. Our team created the EHR design de novo including all of the widgets and interface displays.

How Will Tandem EHR Help?

Tandem EHR will make it easier for clinicians to know their patients as people and partner with them more effectively. Together, clinicians and patients will be able to achieve patient care goals and better disease control. Waste, such as redundant testing, will be reduced. The cognitive workload also will be reduced, leading to less wasted time and attention by primary care teams. This in turn will decrease the dissatisfaction and burnout related to the inadequate support of care by current EHRs.

Our design rigorously follows human factors design principles. We started the design process by selecting font, color and text sizes with high usability. For example, our color scheme was rigorously tested to ensure maximum ability to discriminate colors in color-blind and normal sighted individuals. We brought together our entire team of 15 people — including practicing primary care clinicians and experts in human factors engineering — to develop our prototype design, starting with a high level structure that (unlike most EHRs) is not merely an electronic version of paper charts. We completed an iterative process of design with constant feedback from the same expert team as the designs were fully developed into a functioning prototype.