Choosing What Clinicians See in an Electronic Health Record Can Reduce Cognitive Burden and Improve Decision Making

Giving clinicians the ability to customize the patient electronic health record display reduces cognitive burden, saves time, and supports decision making in busy clinical environments.

Increased provider cognitive burden risks to patient safety from poor EHR design

While the use of EHRs has transformed care, EHRs can often pose a burden for clinicians. Displays in EHRs often force clinicians to navigate through multiple menus and screens to access patient information, including laboratory panels, clinical notes, orders, and medications. This type of data display requires clinicians to remember multiple pieces of complex information from various places and then process it collectively to make care decisions. The disjointed process adds to the cognitive load for clinicians, increases the time needed to develop a treatment plan, and is impractical in busy clinical environments where workflow interruptions are common. These combined factors increase the likelihood of clinician error, which in turn can harm patients.

“I could see there was a big gap between programmers and clinicians and that software often didn’t reflect the way that clinicians work and think. I started wishing that if you could give clinicians the ability to design and create some of their own tools themselves, it might result in better fit to their actual tasks.”
- Dr. Yalini Senathirajah

Selecting what you see in an EHR

Dr. Yalini Senathirajah and a team of researchers at the University of Pittsburgh School of Medicine wanted to know if there was a way to let clinicians decide what information from EHRs they would prefer to see. The team developed and tested an application called MedWISER (Medical Widget-based Information Sharing Environment), which uses a distinctive interaction style in which the user can “compose” or assemble desired information on the same screen, or use preset summaries created by other clinicians within the same health system. As Dr. Senathirajah noted, “With MedWISER, you can place the things you want on the same screen. So you can say, I want to see this lab test, and I want next to it to see the x-ray. And I want this note that the doctor wrote when the patient came in, and I want this graph of the test results from last week. You can assemble the information the way that can help you best make decisions.”

Customizing displays of information to reduce cognitive burden

The research team studied clinicians’ use of the composable MedWISER tool compared with use of a conventional EHR display.

They found that the ability to customize the EHR display reduced clinicians’ cognitive burden, saved time, and supported decision making in high-stress situations.

This research shows that clinicians’ involvement in technology design is integral to ensuring that systems support their work, and does not increase their burden.

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