J Biomed Inform - Effects of time constraints on clinician-computer interaction: a study on information synthesis from EHR clinical notes.

Tópicos

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Resumo

CKGROUND: Time is a measurable and critical resource that affects the quality of services provided in clinical practice. There is limited insight into the effects of time restrictions on clinicians' cognitive processes with the electronic health record (EHR) in providing ambulatory care.OBJECTIVE: To understand the impact of time constraints on clinicians' synthesis of text-based EHR clinical notes.METHODS: We used an established clinician cognitive framework based on a think-aloud protocol. We studied interns' thought processes as they accomplished a set of four preformed ambulatory care clinical scenarios with and without time restrictions in a controlled setting.RESULTS: Interns most often synthesized details relevant to patients' problems and treatment, regardless of whether or not the time available for task performance was restricted. In contrast to previous findings, subsequent information commonly synthesized by clinicians related most commonly to the chronology of clinical events for the unrestricted time observations and to investigative procedures for the time-restricted sessions. There was no significant difference in the mean number of omission errors and incorrect deductions when interns synthesized the EHR clinical notes with and without time restrictions (3.5?0.5 vs. 2.3?0.5, p=0.14).CONCLUSION: Our results suggest that the incidence of errors during clinicians' synthesis of EHR clinical notes is not increased with modest time restrictions, possibly due to effective adjustments of information processing strategies learned from the usual time-constrained nature of patient visits. Further research is required to investigate the effects of similar or more extreme time variations on cognitive processes employed with different levels of expertise, specialty, and with different care settings.

Resumo Limpo

ckground time measur critic resourc affect qualiti servic provid clinic practic limit insight effect time restrict clinician cognit process electron health record ehr provid ambulatori careobject understand impact time constraint clinician synthesi textbas ehr clinic notesmethod use establish clinician cognit framework base thinkaloud protocol studi intern thought process accomplish set four preform ambulatori care clinic scenario without time restrict control settingresult intern often synthes detail relev patient problem treatment regardless whether time avail task perform restrict contrast previous find subsequ inform common synthes clinician relat common chronolog clinic event unrestrict time observ investig procedur timerestrict session signific differ mean number omiss error incorrect deduct intern synthes ehr clinic note without time restrict vs pconclus result suggest incid error clinician synthesi ehr clinic note increas modest time restrict possibl due effect adjust inform process strategi learn usual timeconstrain natur patient visit research requir investig effect similar extrem time variat cognit process employ differ level expertis specialti differ care set

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