Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians
Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians
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DOI：
10.1001/jamanetworkopen.2019.1709
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发表时间：
2019-04-01
影响因子：
13.8
通讯作者：
Marks, Lawrence
中科院分区：
文献类型：
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作者：
Mazur, Lukasz M.;Mosaly, Prithima R.;Marks, Lawrence
重要性：当前的电子健康记录 (EHR) 用户界面设计欠佳，可能与认知工作量过多和表现不佳有关。目的：评估 EHR 系统管理异常测试结果的可用性与医生的认知工作量和表现水平之间的关联。设计、设置和参与者：这项质量改进研究是在模拟 EHR 环境中进行的。从 2016 年 4 月 1 日到 2016 年 12 月 23 日，来自一家大型学术机构的住院医生和研究员被招募并分配使用基线 EHR (n = 20) 或增强型 EHR (n = 18)。数据分析于 2017 年 1 月 9 日至 2018 年 3 月 30 日进行。 干预措施：具有增强可用性的 EHR 隔离在专用文件夹中，之前为未参加预定随访评估的患者确定了关键测试结果，并为后续步骤提供了基于政策的决策支持说明。基线 EHR 在通用文件夹中显示所有具有异常或关键测试结果的患者，并且不提供后续步骤的决策支持说明。 主要结果和措施：使用 NASA 任务负荷指数主观量化认知负荷，并使用眨眼频率进行生理量化。根据适当管理的异常测试结果的百分比对表现进行量化。结果：在 38 名参与者中，25 名 (66%) 是女性。与分配到增强型 EHR 的 18 名参与者相比，分配到基线 EHR 的 20 名参与者表现出统计学上显着更高的认知工作量（按眨眼率量化）（平均 [SD] 每分钟眨眼次数，16 [9] vs 24 [7]；眨眼率，-8 [95% CI，-13 至 -2]；P = .01）。与适当管理异常测试结果 16% 的增强组相比，基线组的表现在统计上显着较差（平均 [SD] 表现，68% [19%] vs 98% [18%]；表现率为 -30% [95% CI，-40% 至 -20%]；P < .001）。结论和相关性：EHR 系统相对基本的可用性增强似乎与更好的医生认知工作量相关和表现；这一发现表明，下一代系统应该消除非增值的 EHR 交互，这可能有助于医生消除开发自己的次优工作流程的需要。
IMPORTANCE: Current electronic health record (EHR) user interfaces are suboptimally designed and may be associated with excess cognitive workload and poor performance.OBJECTIVE: To assess the association between the usability of an EHR system for the management of abnormal test results and physicians' cognitive workload and performance levels.DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted in a simulated EHR environment. From April 1, 2016, to December 23, 2016, residents and fellows from a large academic institution were enrolled and allocated to use either a baseline EHR (n = 20) or an enhanced EHR (n = 18). Data analyses were conducted from January 9, 2017, to March 30, 2018.INTERVENTIONS: The EHR with enhanced usability segregated in a dedicated folder previously identified critical test results for patients who did not appear for a scheduled follow-up evaluation and provided policy-based decision support instructions for next steps. The baseline EHR displayed all patients with abnormal or critical test results in a general folder and provided no decision support instructions for next steps.MAIN OUTCOMES AND MEASURES: Cognitive workload was quantified subjectively using NASA-Task Load Index and physiologically using blink rates. Performance was quantified according to the percentage of appropriately managed abnormal test results.RESULTS: Of the 38 participants, 25 (66%) were female. The 20 participants allocated to the baseline EHR compared with the 18 allocated to the enhanced EHR demonstrated statistically significantly higher cognitive workload as quantified by blink rate (mean [SD] blinks per minute, 16 [9] vs 24 [7]; blink rate, -8 [95% CI, -13 to -2]; P = .01). The baseline group showed statistically significantly poorer performance compared with the enhanced group who appropriately managed 16% more abnormal test results (mean [SD] performance, 68% [19%] vs 98% [18%]; performance rate, -30% [95% CI, -40% to -20%]; P < .001).CONCLUSIONS AND RELEVANCE: Relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non-value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows.