Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation

Abstract

Numerous reports describe unintended consequences of electronic health record implementation. Having previously described physicians' failures to recognize patient safety issues within our electronic health record simulation environment, we now report on our use of eye and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. We linked performance on the simulation to standard eye and screen-tracking readouts including number of fixations, saccades, mouse clicks and screens visited. In addition, we developed an overall Composite Eye Tracking score which measured when, where and how often each safety item was viewed. For 39 participants, the Composite Eye Tracking score correlated with performance on the simulation (p = 0.004). Overall, the improved performance was associated with a pattern of rapid scanning of data manifested by increased number of screens visited (p = 0.001), mouse clicks (p = 0.03) and saccades (p = 0.004). Eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability.

Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record*

“…Alternatively, it represents a coping strategy for an EHR system that does not automatically provide an effective visual display of data needed for daily rounds. Our prior work showed that in order to recognize patient safety issues in simulated MICU patient cases, clinicians had to visit over 30 different EHR screens (15, 35). Thus, the value of the prerounding artifact may be that it gives clinicians a standardized data collection script and creates a single visual display of all rounding data that are otherwise geographically fragmented within the EHR.…”

Impact of Passive Laboratory Alerts on Navigating Electronic Health Records in Intensive Care Simulations

“…In contrast, inexperience has been associated with more gaze fixations, orderly search patterns, and visual neglect of important information, all of which have been observed to correlate with cognitive workload during EHR review (Moacdieh & Sarter, 2015). We have shown that gaze fixation data can predict a user's ability to recognize patient safety issues during simulated ICU rounds (Gold, Stephenson, Gorsuch, Parthasarathy, & Mohan, 2016). These associations provide the basis for using quantitative eye-tracking metrics as surrogates for performance during EHR review tasks.…”

Use of a Novel, Electronic Health Record–Centered, Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues*

“…This role mirrors our real rounds in which the order writer is often not directly involved in the care of the patient being discussed. Workstations were equipped with Tobii studio eyetracking as previously described to allow observation of participants' pre-rounding processes [14]. Once pre-rounding was complete, the intern, nurse, pharmacist and resident gathered to round.…”