Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians

Mazur, Łukasz; Mosaly, Prithima; Moore, Carlton; Marks, Lawrence B.

doi:10.1001/jamanetworkopen.2019.1709

Cited by 83 publications

(114 citation statements)

References 52 publications

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“…Reduce inefficiencies in the registration process with EHR, IT and staffing solutions. 56,57 The study findings indicate that inefficiencies in the registration process due to IT issues were burdensome for healthcare professionals. Therefore, IT systems should be designed in such a way that clinical information is automatically converted to quality indicator information, thereby reducing the number of registrations expected of healthcare professionals.…”

Section: Discussionmentioning

confidence: 94%

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Zegers¹,

Veenstra

Gerritsen

et al. 2020

Int J Health Policy Manag

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Background: Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals’ perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work. Methods: A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer. Results: On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals’ joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality. Conclusion: Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.

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Section: Discussionmentioning

confidence: 94%

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Zegers¹,

Veenstra

Gerritsen

et al. 2020

Int J Health Policy Manag

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“…It should also be noted that the EMR features studied here may already be routine practices in countries such as the UK, which established routine chronic care and facilitated EMR system design support after the introduction of the Quality and Outcomes Framework in 2004. However, with the ongoing concerns surrounding the usability of EMRs in other countries like the USA and Canada,49–51 there is a need for immediate, interim support and training to use existing EMR systems while health informatics researchers, practitioners and vendors work on improving the usability of current and future EMRs. EMR video tutorials may be one educational intervention to support this effort.…”

Section: Discussionmentioning

confidence: 99%

Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care

Randhawa

Shachak

Courtney

et al. 2019

BMJ Health Care Inform

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ObjectiveThis study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR.DesignA QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training.ResultsIn total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286).ConclusionThis small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.

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“…[18][19][20][21] An inefficient EHR can consume the amount of time a clinician spends resulting in cognitive overload, decreased performance levels, clinician stress, and burnout placing patients at risk. 20,[22][23][24][25] Thus, workflow studies that include an analysis of EHR usage are necessary to identify issues and make critical changes to ensure the well-being of patients and clinicians. 26 Our examination of 24/7 EHR usage gave rise to results different from previous time motion studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

et al. 2020

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Background Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. Methods During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. Results Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.–8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.–7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.–8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated. Conclusion We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

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Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians

Cited by 83 publications

References 52 publications

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study

Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

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