A cognitive task analysis of information management strategies in a computerized provider order entry environment
A cognitive task analysis of information management strategies in a computerized provider order entry environment
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DOI：
10.1197/jamia.m2231
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发表时间：
2007-01-01
影响因子：
6.4
通讯作者：
LeBar, Beth
中科院分区：
文献类型：
--
作者：
Weir, Charlene R.;Nebeker, Jonathan J. R.;LeBar, Beth
目标：具有电子文档的计算机化医疗服务提供商订单输入 (CPOE) 和计算机化决策支持极大地改变了执业临床医生的信息环境。先前基于纸张、口头交换和手动方法的工作模式被自动化、计算机化且可能不太灵活的系统所取代。本研究的目的是利用认知任务分析技术探索临床医生在适应 CPOE 系统过程中使用的信息管理策略。设计：对 10 个退伍军人管理局医疗中心的 88 名初级保健临床医生进行观察和半结构化访谈。测量：对访谈进行录音、转录和广泛分析，以确定关键信息管理目标、策略和任务。任务被分组，澄清了任务的共同组成部分，并确定了基本目标和策略。结果：近一半的已确定任务没有得到可用技术的完全支持。确定了任务的六个核心组成部分。出现了四个元认知信息管理目标：1）相关性筛选； 2）确保准确性； 3）最小化内存负载； 4) 谈判责任。提出了用于支持这些目标的策略。结论：用户开发了一系列广泛的信息管理策略，使他们能够成功地适应新技术。支持用户开发自适应策略以支持元认知目标的能力是成功系统的关键组成部分。
Objective: Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques.Design: Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers.Measurements: Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified.Results: Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented.Conclusion: Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.