Usability challenges with electronic health records (EHRs) during prerounding on pediatric inpatients.

Objective: Prerounding is critical for a healthcare team to develop a shared understanding of the patient's condition and to develop a care plan. However, the design of electronic health records (EHRs) often makes prerounding inefficient, ineffective, and time consuming. The goal of this study was to observe how residents use the EHR while prerounding to identify usability challenges associated with the design of EHRs. Materials and Methods: Thirty residents were tasked to preround 2 pediatric patients using the think-aloud protocol. The data from the surveys, video recordings, and think-aloud comments were analyzed to identify usability issues related to EHR. The time it took for participants to complete the 6 required prerounding tasks were calculated and the pages most commonly accessed were noted. Results: Participants spent on average 6.5 min prerounding each patient with the most time spent on checking lab results and reviewing notes. Twenty-eight distinct pages were visited by at least 2 participants, mostly due to a lack of interconnectivity between related data across pages. Usability issues with the most commonly used pages include: data overload, missing/hidden information, difficulty identifying trends, and having to conduct manual calculations. Conclusions: We list usability issues and provide a set of recommendations to remedy these issues that include: reducing information access cost, creating a checklist, automate calculations, and standardizing notes and EHR training. Ideally, the outcome of this work will help improve EHR design to maximize the time clinicians spend interacting with and providing care to their patients.

Transitions Between Low and High Levels of Mental Workload can Improve Multitasking Performance.

OCCUPATIONAL APPLICATIONS Complex and dynamic environments including military operations, healthcare, aviation, and driving require operators to transition seamlessly between levels of mental workload. However, little is known about how the rate of an increase in workload impacts multitasking performance, especially in the context of real-world tasks. We evaluated both gradual and sudden workload increases in the dynamic multitasking environment of an Unmanned Aerial Vehicle (UAV) command and control testbed and compared them to constant workload. Workload transitions were found to improve response time and accuracy compared to when workload was held constant at low or high. These results suggest that workload transitions may allow operators to better regulate mental resources. These findings can also inform the design of operations and technology to assist operators' management of cognitive resources, which include negating the adverse effects of vigilance decrements during low workload periods and data overload during high workload periods.

TECHNICAL ABSTRACT Background High workload and workload transitions can affect performance; however, it is not clear how the rate of transition from low to high workload influences performance in a multitasking setting. Purpose We investigated the effect of workload transition rate on performance in a multitasking environment that is akin to the expectations of operators in complex, data-rich work domains. Method An Unmanned Aerial Vehicle (UAV) command and control testbed was used to vary workload between low, high, gradually transitioning from low to high, and suddenly transitioning from low to high. Performance measures consisted of the response time and accuracy of one primary task and three secondary tasks. Analyses compared: (a) performance differences between gradual and sudden increases in workload; (b) performance during the low workload phases of the workload transitions; and (c) performance during the high workload phases of the workload transitions. Results Overall, there were limited performance differences between gradual and sudden workload transitions. However, both types of transitions led to better performance than constant workload, lending some support for the effort regulation explanation which suggests that participants actively evaluated the amount of mental resources necessary to successfully complete a task after a workload transition. Conclusions Gradual and sudden workload transitions benefit primary and secondary task performance, suggesting that the applicability of existing theoretical explanations depend on the context. For example, varying task demands can be a means to assist operators in the appropriate regulation of mental resources in domains with interdependent tasks. These findings can inform occupation and technology design to support task management.

Now You Feel It, Now You Don't: The Effect of Movement, Cue Complexity, and Body Location on Tactile Change Detection.

OBJECTIVE: To evaluate the effects that movement, cue complexity, and the location of tactile displays on the body have on tactile change detection. BACKGROUND: Tactile displays have been demonstrated as a means to address data overload by offloading the visual and auditory modalities. However, change blindness-the failure to detect changes in a stimulus when changes coincide with another event or disruption in stimulus continuity-has been demonstrated to affect the tactile modality and may be exacerbated during movement. The complexity of tactile cues and locations of tactile displays on the body may also affect the detection of changes in tactile patterns. Limitations to tactile perception need to be examined. METHOD: Twenty-four participants performed a tactile change detection task while sitting, standing, and walking. Tactile cues varied in complexity and included low, medium, and high complexity cues presented to the arm or back. RESULTS: Movement adversely affects tactile change detection as hit rates were the highest while sitting, followed by standing and walking. Cue complexity affected tactile change detection: Low complexity cues resulted in higher detection rates compared with medium and high complexity cues. The arms exhibited better change detection performance than the back. CONCLUSION: The design of tactile displays should consider the effect of movement. Cue complexity should be minimized and decisions about the location of a tactile display should take into account body movements to support tactile perception. APPLICATION: The findings can provide design guidelines to inform tactile display design for data-rich, complex domains.

Tactile, Visual, and Crossmodal Visual-Tactile Change Blindness: The Effect of Transient Type and Task Demands.

OBJECTIVE: The present study examined whether tactile change blindness and crossmodal visual-tactile change blindness occur in the presence of two transient types and whether their incidence is affected by the addition of a concurrent task. BACKGROUND: Multimodal and tactile displays have been proposed as a promising means to overcome data overload and support attention management. To ensure the effectiveness of these displays, researchers must examine possible limitations of human information processing, such as tactile and crossmodal change blindness. METHOD: Twenty participants performed a unmanned aerial vehicle (UAV) monitoring task that included visual and tactile cues. They completed four blocks of 70 trials each, one involving visual transients, the other tactile transients. A search task was added to determine whether increased workload leads to a higher risk of change blindness. RESULTS: The findings confirm that tactile change detection suffers in terms of response accuracy, sensitivity, and response bias in the presence of a tactile transient. Crossmodal visual-tactile change blindness was not observed. Also, change detection was not affected by the addition of the search task and helped reduce response bias. CONCLUSION: Tactile displays can help support multitasking and attention management, but their design needs to account for tactile change blindness. Simultaneous presentation of multiple tactile indications should be avoided as it adversely affects change detection. APPLICATION: The findings from this research will help inform the design of multimodal and tactile interfaces in data-rich domains, such as military operations, aviation, and healthcare.

The Development and Evaluation of Countermeasures to Tactile Change Blindness.

OBJECTIVE: The goal of the present study was to develop and empirically evaluate three countermeasures to tactile change blindness (where a tactile signal is missed in the presence of a tactile transient). Each of these countermeasures relates to a different cognitive step involved in successful change detection. BACKGROUND: To date, change blindness has been studied primarily in vision, but there is limited empirical evidence that the tactile modality may also be subject to this phenomenon. Change blindness raises concerns regarding the robustness of tactile and multimodal interfaces. METHOD: Three countermeasures to tactile change blindness were evaluated in the context of a highly demanding monitoring task. One countermeasure was proactive (alerting the participant to a possible change before it occurred) whereas the other two were adaptive (triggered after the change upon an observed miss). Performance and subjective data were collected. RESULTS: Compared to the baseline condition, all countermeasures improved intramodal tactile change detection. Adaptive measures resulted in the highest detection rates, specifically when signal gradation was employed (i.e., when the intensity of the tactile signal was increased after a miss was observed). CONCLUSION: Adaptive displays can be used to counter the effects of change blindness and ensure that tactile information is reliably detected. Increasing the tactile intensity after a missed change appears most promising and was the preferred countermeasure. APPLICATION: The findings from this study can inform the design of interfaces employing the tactile modality to support monitoring and attention management in data-rich domains.