Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds.
Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds.
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在ICU预装期间，分析医生之间的EHR导航模式和数字工作流程。
DOI：
10.1177/1833358320920589
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Khairat S
中科院分区：
文献类型：
--
作者：
Coleman C;Gotz D;Eaker S;James E;Bice T;Carson S;Khairat S
重症监护病房（icu）的一些医生报告说，电子健康记录（EHRs）可能很麻烦，并且会破坏工作流程。我们对医生与电子病历相互作用的理解存在重大差距。通过对屏幕导航路径和工作流程模式的描述和描述，更好地了解临床医生如何在ICU前查房期间使用电子病历进行图表审查。我们在美国东南部的一个大型学术医疗中心的30张床位的医学ICU进行了一项现场直接观察研究，对6名实习医师在每日查房前进行电子病历复习。观察员使用量身定制的检查表进行数据收集。我们观察了52次不同的现场患者病历回顾，记录了6位医生共2.7小时的舍入前病历回顾活动。医生平均检查了8.7名患者（范围= 5-12），每位患者平均花费3:05分钟（范围= 1:34-5:18）。平均而言，医生为每位患者检查了6.3（±3.1）个电子病历屏幕（范围= 1-16）。四个独特的屏幕是最常见的，占所有屏幕访问的一半以上（52.7%）：结果回顾（17.9%），摘要/概述（13.0%），流程图（12.7%）和图表回顾标签（9.1%）。导航路径变化很大，但在用户中出现了几种常见的屏幕转换模式。配对EHR观察的平均互解释器信度为80.0%。我们观察到，在ICU查房前，医生与电子病历的互动是简短而高度集中的。虽然我们在医生的数字导航中观察到高度的“信息蔓延”，但我们也确定了电子图表审查的共同出发点，关键的高流量屏幕和常见的屏幕转换模式。根据研究结果，我们提出了改进电子病历设计的建议。
Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician–EHR interaction. To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns. We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection. We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5–12), spending a mean of 3:05 minutes per patient (range = 1:34–5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1–16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%. We observed the physician–EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of “information sprawl” in physicians’ digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns. From the study findings, we suggest recommendations towards improved EHR design.
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影响因子：
2.9
作者：
Rizvi, Rubina F.;Marquard, Jenna L.;Melton, Genevieve B.
通讯作者：
Melton, Genevieve B.
影响因子：
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作者：
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通讯作者：
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影响因子：
2.7
作者：
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通讯作者：
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影响因子：
4.5
作者：
Khairat, Saif;Coleman, Cameron;Carson, Shannon S.
通讯作者：
Carson, Shannon S.
DOI：
10.1108/ijhcqa-06-2018-0137
发表时间：
2019-04-15
影响因子：
1.5
作者：
Krawiec, Conrad;Marker, Cristin;Thomas, Neal J.
通讯作者：
Thomas, Neal J.