Spatially Integrated Electronic Health Record Prototype Improves Usability and Reduces Cognitive Load for Intensive...

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Nursing Informatics

Background:

• Traditional linear flowsheet-style electronic health records (EHRs) present challenges in efficiency and usability for intensive care unit (ICU) nurses.
• High cognitive workload associated with EHR documentation can impact nursing performance and job satisfaction.

Purpose of the Study:

• To evaluate the impact of a Spatial Awareness Integrated Electronic Health Record (SAI-EHR) prototype on documentation efficiency, usability, and cognitive workload among ICU nurses.
• To compare the SAI-EHR with a traditional linear interface (LID-EHR) using standardized documentation tasks.

Main Methods:

• A randomized, two-period crossover simulation study involving 36 ICU nurses.
• Nurses completed standardized documentation scenarios using both SAI-EHR and LID-EHR.
• Primary outcomes included documentation time, System Usability Scale (SUS), and NASA Task Load Index (NASA-TLX); secondary outcomes included accuracy and Technology Acceptance Model (TAM) measures.

Main Results:

• SAI-EHR reduced documentation time by 27% (177 seconds faster) and decreased cognitive workload by 51.3% compared to LID-EHR.
• Documentation accuracy was 6.3% higher with SAI-EHR, and the intention to adopt was substantially increased.
• While usability (SUS) and perceived usefulness (TAM-PU) scores favored SAI-EHR, these differences did not reach statistical significance in this sample.

Conclusions:

• The SAI-EHR prototype, by mirroring ICU room layout, demonstrated superior efficiency, accuracy, and reduced cognitive workload compared to linear EHR interfaces.
• Spatial awareness integration is a promising design principle for reducing nurse workload, though larger studies are needed to confirm usability and usefulness.
• Lower cognitive workload correlated with a higher intention to adopt the SAI-EHR system.