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. 2021 Apr 23;28(5):899-906.
doi: 10.1093/jamia/ocaa332.

Impact of a problem-oriented view on clinical data retrieval

Michael G Semanik  1 , Peter C Kleinschmidt  2 , Adam Wright  3 , Duwayne L Willett  4 , Shannon M Dean  1 , Sameh N Saleh  4 , Zoe Co  5 , Emmanuel Sampene  6 , Joel R Buchanan  2
Affiliations

Impact of a problem-oriented view on clinical data retrieval

Michael G Semanik et al. J Am Med Inform Assoc. .

Abstract

Objective: The electronic health record (EHR) data deluge makes data retrieval more difficult, escalating cognitive load and exacerbating clinician burnout. New auto-summarization techniques are needed. The study goal was to determine if problem-oriented view (POV) auto-summaries improve data retrieval workflows. We hypothesized that POV users would perform tasks faster, make fewer errors, be more satisfied with EHR use, and experience less cognitive load as compared with users of the standard view (SV).

Methods: Simple data retrieval tasks were performed in an EHR simulation environment. A randomized block design was used. In the control group (SV), subjects retrieved lab results and medications by navigating to corresponding sections of the electronic record. In the intervention group (POV), subjects clicked on the name of the problem and immediately saw lab results and medications relevant to that problem.

Results: With POV, mean completion time was faster (173 seconds for POV vs 205 seconds for SV; P < .0001), the error rate was lower (3.4% for POV vs 7.7% for SV; P = .0010), user satisfaction was greater (System Usability Scale score 58.5 for POV vs 41.3 for SV; P < .0001), and cognitive task load was less (NASA Task Load Index score 0.72 for POV vs 0.99 for SV; P < .0001).

Discussion: The study demonstrates that using a problem-based auto-summary has a positive impact on 4 aspects of EHR data retrieval, including cognitive load.

Conclusion: EHRs have brought on a data deluge, with increased cognitive load and physician burnout. To mitigate these increases, further development and implementation of auto-summarization functionality and the requisite knowledge base are needed.

Keywords: clinical decision support systems; data display; electronic health records; medical records; problem-oriented; user-computer interface.

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Figures

Figure 1.
Figure 1.
Mockup of a problem-oriented view aggregated data display for epilepsy. The mockup shows lab and medication data and includes links which give access to pertinent data for imaging, procedures and notes.
Figure 2.
Figure 2.
Example of the contents of a problem concept map.
Figure 3.
Figure 3.
The Epic problem-oriented view for chronic systolic congestive heart failure (CHF) selectively displays relevant medications and lab results.
Figure 4.
Figure 4.
Participants were randomized to 1 of 8 sequences, as shown. Blue cases represent the standard view (control) and yellow cases represent the problem-oriented view (intervention).
See this image and copyright information in PMC

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