Toward a better understanding of task demands, workload, and performance during physician-computer interactions

OBJECTIVE: To assess the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment. METHODS: Two experiments were performed in 2 different electronic medical record (EMR) environments: WebCIS (n = 12) and Epic (n = 17). Each participant was instructed to complete a set of prespecified tasks on 3 routine clinical EMR-based scenarios: urinary tract infection (UTI), pneumonia (PN), and heart failure (HF). Task demands were quantified using behavioral responses (click and time analysis). At the end of each scenario, subjective workload was measured using the NASA-Task-Load Index (NASA-TLX). Physiological workload was measured using pupillary dilation and electroencephalography (EEG) data collected throughout the scenarios. Performance was quantified based on the maximum severity of omission errors. RESULTS: Data analysis indicated that the PN and HF scenarios were significantly more demanding than the UTI scenario for participants using WebCIS (P < .01), and that the PN scenario was significantly more demanding than the UTI and HF scenarios for participants using Epic (P < .01). In both experiments, the regression analysis indicated a significant relationship only between task demands and performance (P < .01). DISCUSSION: Results suggest that task demands as experienced by participants are related to participants' performance. Future work may support the notion that task demands could be used as a quality metric that is likely representative of performance, and perhaps patient outcomes. CONCLUSION: The present study is a reasonable next step in a systematic assessment of how task demands and workload are related to performance in EMR-evolving environments

The Influence of Individual Factors and Work Conditions with Nurse's Mental Workload Using Method Nasa-TLX Banggai District Health Center

Workload is the interaction between individuals and things that can burden someone in completing work. The workload is divided into physical and mental, where the workload is influenced by individual characteristics and external factors, task demands, and work environment. The prevalence of workload in the province of Central Sulawesi (50.9%) experienced work stress caused by excessive workload. Banggai Regency is one of the regions in the province of Central Sulawesi. The purpose of this study was to find out how individual characteristics and working conditions can affect the mental workload of nurses at the Banggai District Health Center. this study uses the chi-square method. The sample used in this study is a nurse who is actively working at the Banggai District Health Center. The number of samples used is 225 nurses. The sampling technique is the Slovin technique. The measuring tool used is a research questionnaire from NASA TLX. This questionnaire is used to measure the mental workload of nurses at the Banggai District Health Center. Data were analyzed by univariate and bivariate. The results of this study indicate that the mental workload of nurses in Banggai Regency is in the high category (70.2%). The results of the bivariate analysis found that there was a relationship between age, task demands, work environment and the mental workload of nurses at the Banggai District Health Center (p-value 0.000). There is no relationship between gender and the mental workload of nurses at the Banggai District Health Center. The results of the multivariate analysis of age and task demands have a positive effect on workload, while the work environment has a negative effect on workload. The work environment is the most dominant factor affecting the mental workload of nurses at the Banggai District Health Cente

Assessing the Relationships between Task Demand, Task Difficulty and Performance during Physicians' Interaction with EHR systems

The study’s aim was to relate task demand, task difficulty with performance during physicians’ interaction with electronic health records (EHR) system. The results indicated that there was a significant effect of task demands on task difficulty and performance; task difficulty was also related to performance. Practically, the results suggest that EHR designers might be able to positively affect physicians’ performance by enhancing usability of interfaces aimed at directing physician’ EHR-related interaction strategies.Master of Science in Information Scienc

Usability Heuristic Violations, Provider Burden, and Performance During Interactions with Electronic Health Records

Electronic health records (EHRs) are widely used, but their suboptimal usability can pose risks for patient safety. This study uses data collected in a simulated environment in which providers interacted with ‘current’ and ‘enhanced’ Epic EHR interfaces to manage patients’ test results and missed appointments. Interactions were quantified and categorized by high or low burden in terms of displayed behavioral and physiological data. Using recorded video data, the interface was inspected for violations of usability heuristics, and providers’ workflow and performance was recorded. Overall, 22 heuristic violations were identified from 19 issues across all screens. Suboptimal performance was found to be associated with high burden level as well as the current EHR design. Findings can be incorporated into future design of EHRs in order to reduce providers’ burden.Master of Science in Information Scienc

Efeitos da liderança autêntica e da civilidade na proteção do burnout no local de trabalho

Os resultados sobre a exaustão emocional (indicador chave do burnout) nos profissionais de saúde tem sido foco de preocupação, pelos valores elevados reportados. Relativamente aos enfermeiros, temos indicação de que ocorra em cerca de 2/3 dos casos (Jesus et al., 2014) e em 66% dos médicos (Vala et al., 2016). O estado de saúde destes profissionais tem implicações não só na sua vida pessoal, mas também na qualidade dos cuidados que podem prestar (Smith et al., 2010). As condições do ambiente no trabalho é um dos fatores referidos pela Agência Europeia para a Segurança e Saúde no Trabalho (2012) como determinante para a saúde mental dos trabalhadores, e também para assegurar o seu bom desempenho. Esta é outra forma de promover, especificamente na área da saúde, a qualidade dos cuidados de saúde e a segurança dos utentes (Smith et al., 2010). Um dos aspetos das condições do ambiente no trabalho é a qualidade das relações interpessoais. Um dos seus indicadores é a civilidade, o tratamento de respeito, aceitação, cooperação e justiça na resolução de conflitos. Promover a civilidade é assim outra forma de promover os bons resultados da ação dos profissionais de saúde (Leiter et al., 2011, 2012; Osatuke et al., 2009). Essencial para a qualidade do ambiente de trabalho, e para a promoção e manutenção da civilidade, é a liderança (Walumbwa, Avolio, Gardner, Wernsing & Peterson, 2008; Taheri Otaghsara & Hamzehzadeh, 2017). O presente estudo pretende verificar se a liderança autêntica pode contribuir para a diminuição do burnout no trabalho, tendo a civilidade um papel de mediação. Foram utilizadas as escalas WCS (Osatuke et al., 2009), na versão portuguesa ECT (Nitzsche, 2015), a ALI (Neider & Schriesheim, 2011) e da escala de burnout MBI-GS (Schaufeli, Leiter, Maslach, & Jackson, 1996), numa amostra de 360 profissionais de saúde (enfermeiros, médicos, técnicos de diagnóstico , terapêuticas e assistentes operacionais) de um centro hospitalar público da região de Lisboa. Os resultados do nosso estudo revelam que a liderança autêntica tem um efeito positivo sobre a civilidade no trabalho e que, ambas combinadas oferecem um efeito negativo sobre o burnout. A liderança autêntica apresenta um efeito indireto, através da civilidade, no burnout, mas apenas nas dimensões de exaustão emocional e de cinismo, e não para a eficácia profissional

Identifying Physicians’ User Experience (UX) Pain Points in Using Electronic Health Record (EHR) Systems

Healthcare institutions have migrated to online electronic documentation through the means of Electronic Health Record (EHR) systems. Physicians rely on these systems to support their various clinical work processes, such as entering clinical orders, reviewing essential clinical data, and making important medical decisions using reporting analytics. Although EHR systems appear to be useful and have known advantages over paper records, studies suggest there are persistent user interface design problems that may hinder physician productivity. The study focused on the research problem that EHR system designs create productivity problems for physician users who frequently report that system workflows are inefficient and do not map to their clinical process needs. Although researchers have examined EHR system adaptation and user interface design with various stakeholders, research is limited on the lived experiences of physicians who use the system. A few studies have focused on quantifying the factors that describe the phenomena of “meaningful use” of EHR systems. A qualitative approach to studying the phenomenon of physicians\u27 use of EHR systems is understudied and is relevant to investigate given EHR systems have become commonplace tools in clinical settings. An interpretive phenomenological analysis (IPA) study was conducted with the goal to discover what emergency room physicians describe as the pain points of their user experiences with EHR systems, which may include many different experiences to be uncovered, and their perspectives about how they manage the difficulty of system tasks and demands. Eight participants who represented a purposeful sample were recruited from one hospital in the Southeast region of the United States and participated in semi-structured interviews with open-ended questions. The data derived from the personal lived experiences of the participants were reviewed and analyzed through a step-by-step analytical process to develop five super-ordinate themes: Historical Chart Review, Inadequate Note Documentation, Difficult Order Entry, Patient Throughput Barriers, and Poor System Performance. The findings reveal consistencies with previous research that suggests physicians experience mental burden and burnout using EHR systems due to task complexity, task demand, and inefficiencies of system design. The findings have multiple implications for information technology (IT) system designers, healthcare administrators, and physician end users. This study provides future research opportunities to investigate the experiences of individuals who work in a different specialized area of the hospital, such as the intensive care unit (ICU)

The Development and Evaluation of a Learning Electronic Medical Record System

Electronic medical record (EMR) systems are capturing increasing amounts of data per patient. For clinicians to efficiently and accurately understand a patient’s clinical state, better ways are needed to determine when and how to display patient data. The American Medical Association envisions EMR systems that manage information flow and adjust for context, environment, and user preferences. We developed, implemented, and evaluated a prototype Learning EMR (LEMR) system with the aim of helping make this vision a reality. A LEMR system, as we employ the term, observes clinician information seeking behavior and applies it to direct the future display of patient data. The development of this system was divided into five phases. First, we developed a prototype LEMR interface that served as a testing bed for LEMR experimentation. The LEMR interface was evaluated in two studies: a think aloud study and a usability study. The results from these studies were used to iteratively improve the interface. Second, we tested the accuracy of an inexpensive eye-tracking device and developed an automatic method for mapping eye gaze to patient data displayed in the LEMR interface. In the two studies we showed that an inexpensive eye-tracking device can perform as well as a costlier device intended for research and that the automatic mapping method accurately captures the patient information a user is viewing. Third, we collected observations of clinician information seeking behavior in the LEMR system. In three studies we evaluated different observation methods and applied those methods to collect training data. Fourth, we used machine learning on the training data to model clinician information seeking behavior. The models predict information that clinicians will seek in a given clinical context. Fifth, we applied the models to direct the display of patient data in a prospective evaluation of the LEMR system. The evaluation found that the system reduced the amount of time it takes for clinicians to prepare for morning rounds and highlighted about half of the patient data that clinicians seek

Atheoretical Versus Theory-Based Approaches in Promoting Safer ADHD-Medication Prescribing for Adults

Gaps between treatment guidelines and medical decisions persist despite interventions with physicians, which are mostly atheoretical. The purpose of this retrospective cross-sectional study was to compare atheoretical and theory-based logistic regression models of a binary outcome: potentially unsafe prescribing of attention-deficit hyperactivity disorder (ADHD) medications to adults. Social cognitive theory and self-determination theory provided the framework for the study. Predictors were framed as social cognitive theoretical constructs: knowledge (e.g., physician specialty) and environmental influence (e.g., interventions). Atheoretical hypotheses were based on legislation mandating meaningful use of electronic health records and computerized decision support (CDS). Theory-based hypotheses were derived from literature on cognition in medicine and on the controlled motivation construct in self-determination theory. Research questions addressed associations of CDS and meaningful use with the outcome and fit of competing models. The sample included office-based physician visits made by patients aged \u3e 17 years with ADHD (n = 810) or potentially unsafe medical conditions (n = 9,101), recorded in a U.S. database in 2014–2016. Findings for the atheoretical model were reduced odds of the outcome with CDS, and nonsignificant improvement in model fit using theory. Supporting the self-determination theory-based hypothesis, odds were increased with meaningful use. This study adds to research suggesting autonomy as a core issue in medicine. Positive social change may result from psychology-based strategies to empower physicians through participation in developing clinically relevant information systems