Understanding Primary Care Teamwork in Context: Implications for Health Information Technology Design (Wisconsin)

Current electronic health records (EHRs) do not provide cognitive support for clinicians. Cognitive work refers to the processes used toward goal-directed work, which includes information seeking, situation assessment, problem identification, and problem solving, such as the work needed to make a clinical diagnosis. Most EHR systems are designed with multiple unique screens. Navigating across these screens demands time and cognitive resources to avoid getting lost in the data. This forces busy clinicians to allocate cognitive resources to holding information in memory while clicking through screens, detracting them from the cognitive work needed to focus on providing good patient care. In addition, EHRs require clinicians to read through less relevant information to find what they need, impose excessive data entry burdens, and present redundant data. Many of these issues could be resolved through improved design.

This project will inform the design of EHRs to support the cognitive work of primary care clinicians and teams. Its long-term goal is to develop new EHR interfaces, data displays, and input requirements, which can be implemented by developers of EHRs. These new interfaces also will support and extend clinician and team cognitive work to improve patient outcomes.

The specific aims of the project are as follows:

• Identify the cognitive work requirements of primary care clinicians and teams
• Develop and test specific EHR interface design requirements

The project team will conduct a 5-year study to assess the cognitive and team work of primary care clinicians and teams. In a systematic way, they will identify the cognitive work requirements of primary care physicians, mid-level providers, and nurses, individually and as a team, to provide optimal care for their adult patients. A complete, goal-directed task analysis will be conducted for primary care provider-nurse cognitive work requirements to determine the required data elements, data forms, and nature of integration to support them. These cognitive work requirements will then be used to develop and test EHR design requirements. Once completed, a final set of EHR design requirements for primary care clinicians and teams will be produced.