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How do Clinicians Use Electronic Health Records for Respiratory Support Decisions? A Qualitative Study in Critical
Tianyi Zhang1, Jarrod Mosier2, Vignesh Subbian1
1College of Engineering, University of Arizona, Tucson, Arizona, United States.
ACI Open
|July 29, 2026
Summary
Clinicians use electronic health records (EHR) in intensive care units (ICUs) with fragmented information and workarounds, impacting respiratory support decisions. Opportunities exist for improved clinical decision support (CDS) integration within EHR systems.
Area of Science:
- Critical Care Medicine
- Health Informatics
- Human-Computer Interaction
Background:
- Selecting respiratory support in critical care is complex, often requiring data unavailable at the time of decision.
- Electronic health records (EHR) are vital for managing respiratory failure patients but their use in decision-making for respiratory support is understudied.
Purpose of the Study:
- To understand how clinicians utilize EHRs for decision-making concerning respiratory support in intensive care units (ICUs).
Main Methods:
- A socio-technical systems approach was employed, involving 35 hours of observation across nine care teams in two ICUs.
- Journey mapping illustrated clinicians' respiratory support decision-making processes.
- Barriers were identified and characterized using macro-cognitive functions to define EHR use patterns.
Main Results:
- Three themes emerged: fragmented information for individual sensemaking, EHR workarounds for collaboration, and interruptive order entry/execution.
- These themes correspond to distinct stages of decision-making (before, during, after morning rounds).
- EHR interaction varied significantly across these decision-making stages.
Conclusions:
- EHR use patterns for respiratory support decisions differ significantly before, during, and after morning rounds.
- Findings suggest potential for integrating diagnostic clinical decision support (CDS) into EHRs to aid respiratory support decisions.
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