Cognitive Engineering for Complex Decisionmaking & Problem Solving in Acute Care (Maryland)

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Health care is a complex, high-risk, socio-technical work environment. As complexity increases and technology advances, there is an increasing need for “intelligent” design of health information technology (IT) to better support the health care providers that use the technology. Although billions of Federal dollars have been spent to support the rapid national integration of IT into health care, health care workers still struggle to integrate these systems into their workflow and fully exploit its potential. Optimally designed health IT systems must support health care providers’ cognitive work, workflow, and decisionmaking needs, rather than requiring providers to adapt their cognitive work and workflow to meet the requirements of the system.

The key to successful health IT is presenting the right information at the right time visualized in a way that facilitates insightful interpretation with functionality that helps the user perform their work quickly and safely. The proposed research applies cognitive engineering methods to understand and support complex cognition and work activities in the emergency department (ED). The ED is an ideal setting for this research because it has some of the most challenging conditions for cognitive work--including high risk, time pressure, and uncertainty--and, therefore, provides a strong opportunity to generalize findings to other complex health care environments.

The specific aims of this project are as follows:

  • Perform a cognitive engineering analysis of emergency medicine across diverse health care environments, including rural, inner-city, teaching, and community health care settings. 
  • Define design guidance and solutions based on identified needs, and develop testable prototypes that integrate these design criteria. 
  • Evaluate prototypes with usability methods and realistic simulated tasks set in a clinical simulation center. 
  • Disseminate results to health IT developers, researchers, and scientists to allow integration of the findings into future designs of technology solutions. 

Contributions from this research will include a fundamental understanding of the nature of cognition and clinical work in a high-intensity medical environment, providing a basis for the design of health IT solutions that support clinical work and improve the effectiveness of medical care.

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