Effects of CPOE on provider cognitive workload: a randomized crossover trial

Area of Science:

• Medical Informatics
• Surgical Workflow Optimization
• Human-Computer Interaction in Healthcare

Background:

• Clinical decision support systems (CDSS) aim to improve patient care and reduce errors.
• The usability and cognitive impact of systematically developed CDSS are not fully understood.
• Order sets are a common form of CDSS in surgical settings.

Purpose of the Study:

• To evaluate the usability benefits of systematically developed clinical decision supports.
• To assess the impact of these supports on surgeon cognitive workload.
• To compare systematically developed order sets with ad hoc developed ones.

Main Methods:

• A randomized crossover trial involving seven surgeons at a pediatric hospital.
• Surgeons used both systematically developed and ad hoc developed order sets for pediatric appendicitis postoperative management.
• Data collected included videorecordings, System Usability Scale, and NASA-Task Load Index scores.

Main Results:

• Systematically developed order sets were unanimously preferred by participants.
• Higher usability scores (75 ± 10 vs 60 ± 19) and lower cognitive workload scores (37.7 ± 15 vs 52.2 ± 12) were observed.
• Order sets led to greater adherence to clinical guidelines without significant differences in time, clicks, or free text entry.

Conclusions:

• Systematically designed order sets enhance system usability and guideline adherence.
• These supports effectively reduce cognitive workload and order variation in surgical care.
• No significant improvements were found in time spent, mouse clicks, or free text entry.