Quantifying Electronic Medical Record Usability to Improve Clinical Workflow

描述（由申请人提供）：我们建议进行一项前瞻性临床研究，以了解使用电子病历的门诊诊所如何实际完成临床工作，并探索电子病历使用、工作流程、医患沟通、认知负荷和用户满意度之间的关系。拟议的研究将采用与项目的知识发现目标一致的观察性前瞻性设计。该研究将在VA圣地亚哥和加州大学圣地亚哥分校（UCSD）医疗保健系统的门诊诊所进行。在门诊领域，我们将研究2个用例场景（初级保健诊所和医学专科诊所）。我们建议在2个地点招募和研究32名提供者和192名患者（6次单独的患者就诊/提供者）。提出了一种多面互补的数据收集模式来研究EMR的可用性、工作流程、通信和认知负荷。EMR用户界面活动，包括鼠标点击事件和屏幕活动，将通过可用性软件进行记录。视频将临时编码为通信和工作流行为。调查将用于测量满意度和认知负荷。该分析包括开发一系列流程级定量测量和电子病历使用指标、临床工作流程和提供者-患者沟通。我们将把EMR使用和临床工作的数据联系起来，以开发EMR可用性、临床工作流程和提供者认知负荷的复合模型，并将探索这些指标在研究地点（UCSD和VA）、提供者类型（初级和专科）、患者就诊和EMR （CPRS和EPIC）之间的关联，同时考虑重要的共变量。本研究将提供可用性、工作流程、沟通和认知负荷的综合评估。这些关键知识可以为下一代以用户为中心的电子病历的开发提供信息，从而提高临床表现和有效性。

DESCRIPTION (provided by applicant): We propose to conduct a prospective clinical study to understand how clinical work is actually done in outpatient clinics that use EMRs, and to explore associations between EMR usage, workflow, physician-patient communication, cognitive load, and user satisfaction. The proposed study will use an observational prospective design consistent with the knowledge discovery goals of the project. The study will be conducted in the outpatient clinics at VA San Diego and at University of California San Diego (UCSD) Healthcare System. Within the outpatient arena, we will study 2 use case scenarios (primary care clinics and medical specialty clinics). We propose to recruit and study 32 providers and 192 patients (6 unique patient visits/provider) across 2 sites. A multifaceted and complementary data collection schema is proposed to study EMR usability, workflow, communication, and cognitive load. EMR user-interface activity, including mouse-click events and screen activity, will be logged via usability software. Videos will be temporally coded for communication and workflow behaviors. Surveys will be used to measure satisfaction and cognitive load. The analysis consists of development of a range of process-level quantitative measures and indicators of EMR usage, clinical workflow, and provider-patient communication. We will link data on EMR use and clinical work to develop composite models of EMR usability, clinical workflow, and provider's cognitive load and will explore associations between these indicators across study sites (UCSD and VA), provider types (Primary and Specialty), patient visits, and EMRs (CPRS and EPIC) while accounting for important covariates. The present study will provide a comprehensive assessment of usability, workflow, communication, and cognitive load. This critical knowledge can inform the development of the next generation of user-centered EMRs, hence improving clinical performance and effectiveness.