Association between ICU interruptions and physicians trainees' electronic health records efficiency.

The intensive care unit (ICU) is a stressful and complex environment in due to its dynamic nature and severity of admitted patients. EHR interface design can be cumbersome and lead to prolonged times to complete tasks. This paper investigated the relationship between a prominent EHR interface design and interruptions with physician's efficiency during patient chart review at ICU Pre-Rounds. We conducted a live observation of ICU physicians in a 30-bed MICU at a tertiary, southeastern medical center. Directly after the observation sessions, the physicians completed a modified System Usability Scale (SUS) survey. A total of 52 EHR patient chart reviews were observed at the MICU Pre-rounds. There was statistically significant positive correlation between time spent to review patient EHR with both number of scrolling(p-value<0.0001) across EHR interface; and with number of visited EHR  screens (p-value=0.0444). There was positive correlation between number of interruptions with time spent to review patient EHR during ICU prerounds. EHR design and the occurrence of interruptions lead to reduced physician-EHR efficiency levels. We report that the number of scrolling and visited screens executed by physicians to gather the required information was associated with increased screen time and consequently decreased physician efficiency.

Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds.

BACKGROUND: Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician-EHR interaction. OBJECTIVE: To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns. METHOD: We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection. RESULTS: We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5-12), spending a mean of 3:05 minutes per patient (range = 1:34-5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1-16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%. CONCLUSION: We observed the physician-EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of "information sprawl" in physicians' digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns. IMPLICATIONS: From the study findings, we suggest recommendations towards improved EHR design.