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EMR的门诊诊所实际上是如何完成临床工作的，并探索EMR使用、工作流程、医患沟通、认知负荷和用户满意度之间的关联。拟议的研究将使用与项目的知识发现目标一致的观察性前瞻性设计。本研究将在VA San Diego和加州大学圣地亚哥分校（UCSD）医疗保健系统的门诊进行。在门诊竞技场中，我们将研究2个用例场景（初级护理诊所和医学专科诊所）。我们建议在2个研究中心招募和研究32名提供者和192名患者（6名患者访视/提供者）。一个多方面的和互补的数据收集模式，提出了研究电子病历的可用性，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）将通过可用性软件记录。视频将根据通信和工作流行为进行时间编码。调查将用于衡量满意度和认知负荷。该分析包括开发一系列过程级定量测量和EMR使用指标，临床工作流程和提供者-患者沟通。我们将链接EMR使用和临床工作的数据，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，并将探索研究中心（UCSD和VA），提供者类型（主要和专业），患者访视和EMR（CPRS和EPIC）之间的这些指标之间的关联，同时考虑重要的协变量。本研究将提供一个全面的可用性，工作流程，沟通和认知负荷的评估。这些关键知识可以为下一代以用户为中心的EMR的开发提供信息，从而提高临床性能和有效性。 公共卫生相关性：该项目解决了基础研究的需要，以了解电子病历（EMR）技术如何用于门诊临床咨询。该项目将进行详细的分析EMR相关的任务，医患沟通，医生的认知负荷，病人和医生的满意度。该项目直接关系到AHRQ的主要兴趣领域#1：临床工作的性质-“了解临床工作是如何完成的，如何完成，以及如何进行工作的背景影响任务和信息需求”。我们相信，我们的提案符合AHRQ的使命，即为所有美国人提高医疗保健的质量、安全性、效率和有效性。

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. PUBLIC HEALTH RELEVANCE: The project addresses the need for basic research to understand how Electronic Medical Record (EMR) technology is used in outpatient clinical consultations. The project will perform detailed analyses of EMR- related tasks, physician-patient communication, physicians' cognitive load, and patient and physician satisfaction. The project is directly related to AHRQ's major area of interest # 1: The nature of clinical work in context - "understanding how clinical work is done, how it could be done, and how the context in which work is carried out affects both tasks and information needs". We believe our proposal is in line with AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans.