Evaluating Cognitive Load in Clinical Workflows Highlights Leverage Points for Guideline-Concordant Statin Initiation

Area of Science:

• Health Informatics
• Clinical Decision Support
• Primary Care Research

Background:

• Electronic Health Records (EHRs) are integral to modern healthcare, yet their impact on clinician cognitive load and care quality requires further investigation.
• Understanding the relationship between EHR use and clinical decision-making is crucial for optimizing healthcare delivery and closing care gaps.
• Statin prescribing guidelines aim to prevent cardiovascular events, but adherence can be influenced by complex clinical workflows.

Purpose of the Study:

• To investigate how EHR metadata can quantify cognitive load in primary care providers (PCPs) during statin prescribing.
• To identify specific EHR workflow events that contribute to cognitive load and impact statin initiation.
• To explore the association between cognitive load metrics and the rate of statin initiation.

Main Methods:

• Retrospective analysis of EHR primary care encounter data from a large academic health system.
• Calculation of ASCVD risk scores for adult patients meeting statin initiation criteria.
• Derivation of cognitive load metrics from EHR metadata, utilizing logistic regressions and gradient-boosted forests with SHAP values.

Main Results:

• Increased encounter duration correlated with higher statin initiation likelihood, while more time per EHR event decreased it.
• Non-linear relationships were found between cognitive load indicators (loop count, distinct event count) and statin initiation probability.
• Average time per event was the strongest predictor of statin initiation, with reviewing lab results and using order sets also positively associated.

Conclusions:

• EHR metadata can effectively link cognitive load to clinical behaviors like statin prescribing.
• Non-linear associations between cognitive load and statin initiation highlight the complexity of EHR-influenced decision-making.
• Optimizing EHR systems to reduce cognitive burden is essential for improving guideline adherence and patient care outcomes.