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EMR Usability and Cognitive Task Load

talk @ UCSD bioinfo 4.2011

Alan Calvitti

on 21 February 2012

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Transcript of EMR Usability and Cognitive Task Load

electronic medical records
usability and cognitive task load alphabet soups: emr: electronic medical record
ehr: electronic health record
phr: personal health record alan calvitti phd
health srvc r&d va san diego "usability" (iso 9241-11) "usability is the effectiveness, efficiency and satisfaction with
which the intended users can achieve their tasks in the intended
context of product use" usability is not utility
effectiveness: facilitate users in accomplishing goals
efficiency: time required to complete tasks
satisfaction: subjective user perception nist "user centered design" understand user needs, workflows, environments
engage users early/often
set user performance objectives
design ui from known behavior principles
conduct usability tests
adapt design iteratively pilot: gaze+verbal physician gaze
chromograms n=9 sample physician + patient utterances key result: gaze+emr behavior 'signatures' key result: verbal comm is extensive emr in the news pace: n=17 mouse activity observational study
6 established patients per primary care physician, 30x VA+UCSD?
office visit, minimally intrusive room camera + emr capture
multi-modal ethnographic profiling
hierarchical + sequential usability & cognitive load modeling methods detour #1 now: exploratory data analysis +viz key result:emr use extensive emr (vista/cprs) mouse activity actograms manual coding of click events to categories categories per-visit mouse activity summary key result: 100s of clicks/visit phys+patient survey outcomes key result: noisy. factor analysis needed theory: cognitive task load neerincx's task load cube pace: anatomy of 'red zone' 2 sample visits: mouse + gaze mouse activity
transition graphs visit 1
32:45 visit 2
40:44 physician gaze summary measures from graphs van mieghem "graph spectra for complex networks"2011 human-coded mouse click categories (hierarchical analysis)
x-->y arc labels: {# observed transitions, transition times}
rank-order n-grams (~nlp), n=1,2,3... 1= most freq click type
common subgraphs
codiveristy of graph measures: topological, spectral, metric.. . from study of operator task load
royal netherlands navy emr usability requires
"systems" thinking patient-centered emr "pace" study pi: zia agha (vasd)
eda+viz: alan calvitti (vasd) s hurst (vasd), r street (ut austin), y chen (uci), k bell (vasd), n farber (ucsd), d zuest (vasd), l pua (vasd), b gray (vasd), f adegbemle (sdsu), s feupe (sdsu) key result: high invididual variation --> clicks--> ergonomics & cognitive task load time-domain profiling time-domain profiling (hierarchical+sequential) pace: n=17 survey outcomes summary: tot pts missed l8r: large var --> factor analysis stability? methods detour #2 computational co-heterogeneity time-domain profiling, covariates, mouse transition graphs "surveys can be helpful but need to be paired with other data sources"
patient-centered is not just patient-satisfaction + effective
+ efficient
+ safe
+ patient-centered
+ timely
+ equitable berwick: "what patient centerdness should mean" elements: count, average, rank-order methods detour #3 "compromise words surfaced" + "partnership"
+ "sharing"
+ "respect for patients"
+ "responsive to individual preferences" health affairs 2009 iom 2001 goals
for quality care utterance categories include
+ biomed talk (most common) @ bottom
+ psychosocial
+ distinction b/w open- vs closed- q's nist<--ahrq<--hhs-->ansi-->hitsp entelons, units, scales of measurement study limitations: complexity patient-centered care =
cognitively demanding
tasks ~79 age (diff anon) ~67
5 reasons for visit 4 methods detour #4 surveys require composite scales importance of the narrative component in ambulatory care problems with surveys emr meaningful use
utility-->usability standards? alternative models of cognition.. . range of specificity disease---illness gap inpatient---outpatient duality the computer in the room variety of confounders summary hi-res ethnographic profiling achievable (w/ manual coding)
multi-modal integration likely to yield workflow & emr usability measures
patient-centerdess is a complex (bio-, behavioral-, values- heterogeneity) "it does not appear that the physician studies even health in the abstract:
he studies the health of the human being - or rather some particular human being
for it is individuals he has to cure"
-- aristotle "n. ethics i"
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