The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health

Thursday, April 18, 2019

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

Readers have little trouble finding articles about electronic health records. Unfortunately, most users have little good to say about their EHR except that is has a good memory and never forgets. The trouble lies in data entry and its interference with clinical workflow.


 This JAMA article by Lukasz M. Mazur, PhD1,2,3; Prithima R. Mosaly, PhD1,2,3 Carlton Moore, MD1,2,4 Carleton Moore M.D.; et al .  asks and elaborates on several key questions.

Key Points

Question  Is enhanced usability of an electronic health record system associated with physician cognitive workload and performance?
Findings  In this quality improvement study, physicians allocated to perform tasks in an electronic health record system with enhancement demonstrated statistically significantly lower cognitive workload; those who used a system with enhanced longitudinal tracking appropriately managed statistically significantly more abnormal test results compared with physicians allocated to use the baseline electronic health record.
Meaning  Usability improvements in electronic health records appear to be associated with improved cognitive workload and performance levels among clinicians; this finding suggests that next-generation systems should strip away non–value-added interactions.
This deficit has been recognized by those developers who design EHR.  Good news! It has been a long time coming! 
Importance  Current electronic health record (EHR) user interfaces are suboptimally designed and may be associated with excess cognitive workload and poor performance.

 Objective  To assess the association between the usability of an EHR system for the management of abnormal test results and physicians’ cognitive workload and performance levels. Relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non–value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows.

 Study setting:

 This quality improvement study was conducted in a simulated EHR environment. From April 1, 2016, to December 23, 2016, residents and fellows from a large academic institution were enrolled and allocated to use either a baseline EHR (n = 20) or an enhanced EHR (n = 18). Data analyses were conducted from January 9, 2017, to March 30, 2018. The study was done using GCP and sound scientific guidelines for constructing a reliable and credible study.

 The simulated scenarios were iteratively developed and tested by an experienced physician and human factors engineer (C.M. and L.M.) in collaboration with an Epic software developer from the participating institution. The process included functionality and usability testing and took approximately 12 weeks to complete. The experimental design was based on previous findings that attending physicians use the EHR to manage approximately 57 test results per day over multiple interactions.22,23 

 At the conclusion of the study, an evaluation of the changes was performed based upon Perceived Workload, Physiological Workload, and Performance.  In addition to these factors, Secondary Outcome and Measures were evaluated.
Fatigue can affect perceived and physiological workload and performance and thus can confound study results.41-43 Because of the possible confounding association of fatigue, participants were asked to evaluate their own state of fatigue immediately before each simulated session using the fatigue portion of the Crew Status Survey.44 The fatigue assessment scale included these levels: 1 (fully alert, wide awake, or extremely peppy), 2 (very lively, or responsive but not at peak), 3 (okay, or somewhat fresh), 4 (a little tired, or less than fresh), 5 (moderately tired, or let down), 6 (extremely tired, or very difficult to concentrate), and 7 (completely exhausted, unable to function effectively, or ready to drop). The Crew Status Survey has been tested in real and simulated environments and has been found to be both reliable and able to discriminate between fatigue levels.44,45

Relatively basic usability enhancements to EHR systems appear to be associated with improving physician management of abnormal test results while reducing cognitive workload. The findings from this study support the proactive evaluation of other similar usability enhancements that can be applied to other interfaces within EHRs.

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Help may be on the way.

The electronic health record evaluated was EPIC. Epic is the largest provider (if not one of the top three) for a large group and/or hospitals.


 Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians. | Electronic Health Records | JAMA Network Open | JAMA Network: Question  Is enhanced usability of an electronic health record system associated with physician cognitive workload and performance?
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