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Related Concept Videos

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Measuring the Switch Cost of Smartphone Use While Walking
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Measuring the cognitive effort associated with task switching in routine EHR-based tasks.

Brian Bartek1, Sunny S Lou2, Thomas Kannampallil3

  • 1Institute for Informatics, School of Medicine, Washington University in St Louis, St Louis, MO, United States.

Journal of Biomedical Informatics
|April 4, 2023
PubMed
Summary
This summary is machine-generated.

Switching tasks in electronic health records (EHR) increases cognitive burden and time spent on clinical duties. Understanding these switch costs is crucial for optimizing EHR workflows and reducing physician workload.

Keywords:
Cognitive burdenCognitive scienceEHR audit logsSwitch costsTask switching

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Area of Science:

  • Health Informatics
  • Cognitive Science
  • Human-Computer Interaction

Background:

  • Clinical practice involves frequent, time-sensitive tasks requiring attention switching.
  • Electronic Health Records (EHR) are central to modern clinical workflows.
  • Task switching imposes a cognitive burden, impacting efficiency and potentially leading to errors.

Purpose of the Study:

  • To develop a method for quantifying task-switching costs using EHR audit logs.
  • To assess the magnitude of cognitive burden during routine EHR-based clinical tasks.
  • To identify specific EHR tasks associated with significant switch costs.

Main Methods:

  • Utilized EHR-based audit logs from 75 physician trainees over a longitudinal study.
  • Developed a taxonomy of EHR tasks from audit log actions.
  • Analyzed task sequences to identify task switches and compare time spent on post-switch vs. non-switch tasks using mixed-effects regression.

Main Results:

  • Analyzed over 2.7 million audit log events, revealing significant time spent on chart review, note review, and EHR navigation.
  • Task switching was associated with increased time for documentation, order entry, and results review (median increases of 5s, 3s, and 3s, respectively).
  • Mixed-effects models confirmed longer task durations following a switch (β=0.03), particularly for imaging, order entry, and note review tasks.

Conclusions:

  • Task switching in EHR environments represents a significant and prevalent cognitive burden.
  • Cumulative switch costs can impact overall EHR workload, physician wellness, and patient safety.
  • Pragmatic design considerations are needed to mitigate the cognitive burden associated with frequent task switching in EHR systems.