Improving Providers’ Decision-Making and Reducing Information Overload Using Information Visualization in Electronic Health Records

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Project Summary/Abstract Importance: Poor design of electronic health records (EHR) can cause providers to overlook crucial data, consequently impeding decision-making and adversely affecting patient safety and quality of care. Typically spending 3.3 hours per day using the EHR, ICU providers monitor 2.5 million data points per month and respond to 187 alerts per patient per day Visualization is the science of transforming textual data into a visual display. Dashboards are novel information visualization methods to organize data and hold the potential to reduce information and cognitive overload, thereby improving providers' decision-making through increased efficiency and reliability. Objective: Our goal is to investigate the efficacy of novel information visualization methods to improve ICU providers' decision-making, efficiency, and satisfaction. Specific aims: (1) Characterize the effect of EHR information overload on the quality of care by measuring prescribing providers' performance, information seeking load, information processing load using real-time patient data in institutional Epic® and Cerner® EHR in a laboratory setting. (2) Evaluate the effect of information visualization on providers' decision making; performance; efficiency; fatigue; workload; and satisfaction through real patient data in a randomized controlled trial. (3) Determine the acceptability, ease of use, and barriers to implementing information visualization dashboards into practice in an ICU setting, using guided interviews with ICU providers. Study Design: We will recruit ICU providers from four academic medical centers: two Epic® sites (UNC, Mayo Clinic) and two Cerner® sites (MedStar, University of Pittsburgh). The first study will aim to characterize the effect of current EHR information overload on providers' information processing abilities. Second, we will test the efficacy using an information visualization dashboard to improve the decision-making, efficiency, performance of providers compared to their institutional HER through a randomized trial. Third, we will conduct guided interviews to understand provider's perceptions around the implementation and use of visualization dashboard in real ICU settings. Discussion: We anticipate that completion of these aims will yield the following outcomes: 1) to add new knowledge around information overload-related patient safety risks in current EHRs; 2) to determine the efficacy of a visualization tool compared to prominent EHR interfaces Epic® and Cerner®; and 3) to create new knowledge around visualization implementation guidelines and usability best-practices. Because the visualization tool may improve the decision-making process for providers, we expect its use will increase patient safety and decrease the number of medical errors.