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SummaryCognitive systems engineering methods can be used to design Emergency Department information systems. TeamMedStar Health National Center for Human Factors in Healthcare |
BackgroundHealth information systems are rapidly being implemented in a variety of healthcare contexts, including Emergency Departments (EDs). These systems offer promising solutions to challenges related to cost, efficiency, patient safety, and medical errors. New technologies are often designed with only a limited understanding of the nature of cognition, tasks, and workflow in the setting in which they will be used. Without a careful understanding of how new technologies will be used in practice, unanticipated or undesirable consequences can arise. From increased workload to “workarounds,” patient and provider safety can be compromised if systems and tasks are bypassed, abandoned, or interrupted. To address these deficits, MedStar Health National Center for Human Factors in Healthcare and MedStar Emergency Physicians recognized an opportunity to leverage their partnership—one of the few existing collaborations between human factors scientists, informaticians, and clinicians. They partnered with the University at Buffalo’s Department of Industrial Engineering to use cognitive systems engineering (CSE) methods to design and test prototype ED information systems. Together, they worked to understand how new technologies will be used in practice, the cognitive work technologies support, and how technologies’ design can be optimized for this support. While there have been applications of cognitive engineering to medical environments, none have provided a comprehensive understanding of the nature of cognitive clinical work and activities across an acute care environment. The research supported by this partnership has continued to grow and has received R01 grant funding for the past five years (R01HS022542; Fairbanks/Hettinger). |
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Impact
To date, three main prototypes have been iteratively developed and evaluated leveraging usability methods.
| Workload Display: Embedded in the electronic health record (EHR), this tool visually quantifies the individual work associated with given patients while monitoring the distribution of work across clinicians in real-time. Key display features include patients represented by a bar with a length relative to the workload of the given patient and color-coded by their current phase of care, as well as the ability for staff to assess workload at a glance and decide which provider has the capacity to take on more patients. The algorithm is continually refined for improved accuracy. |
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| Patient-Centered Display: Issues have arisen from the transition from manual to electronic patient status boards. The patient information display, which includes distinct sections of information, was developed to improve information accessibility for nurses and physicians. Feedback from the usability evaluation will be shared with existing EHR vendors to incorporate into future designs. |
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| Clinical Event Timeliner: This tool, also embedded in the EHR, can be used in real-time and aggregates all of a patient’s clinical events (labs, imaging, medications, and documentation) into a timeline-based view in order to improve the post-encounter event review process. Users of this tool can identify relationships between data elements based on the time of order and time of result. It is currently being used by MedStar safety and clinical personnel to perform chart reviews and day-to-day clinical tasks. |
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