Institute for Health Informatics, University of Minnesota, MMC 912 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
J Biomed Inform. 2013 Dec;46(6):1136-44. doi: 10.1016/j.jbi.2013.08.009. Epub 2013 Sep 6.
Time is a measurable and critical resource that affects the quality of services provided in clinical practice. There is limited insight into the effects of time restrictions on clinicians' cognitive processes with the electronic health record (EHR) in providing ambulatory care.
To understand the impact of time constraints on clinicians' synthesis of text-based EHR clinical notes.
We used an established clinician cognitive framework based on a think-aloud protocol. We studied interns' thought processes as they accomplished a set of four preformed ambulatory care clinical scenarios with and without time restrictions in a controlled setting.
Interns most often synthesized details relevant to patients' problems and treatment, regardless of whether or not the time available for task performance was restricted. In contrast to previous findings, subsequent information commonly synthesized by clinicians related most commonly to the chronology of clinical events for the unrestricted time observations and to investigative procedures for the time-restricted sessions. There was no significant difference in the mean number of omission errors and incorrect deductions when interns synthesized the EHR clinical notes with and without time restrictions (3.5±0.5 vs. 2.3±0.5, p=0.14).
Our results suggest that the incidence of errors during clinicians' synthesis of EHR clinical notes is not increased with modest time restrictions, possibly due to effective adjustments of information processing strategies learned from the usual time-constrained nature of patient visits. Further research is required to investigate the effects of similar or more extreme time variations on cognitive processes employed with different levels of expertise, specialty, and with different care settings.
时间是一种可衡量且关键的资源，它会影响临床实践中服务的质量。对于时间限制对临床医生在提供门诊护理时使用电子健康记录（EHR）的认知过程的影响，我们的了解有限。
了解时间限制对临床医生综合基于文本的 EHR 临床记录的认知过程的影响。
我们使用了基于出声思维协议的既定临床医生认知框架。我们在受控环境中，研究了实习医生在有和没有时间限制的情况下完成四个预先设定的门诊护理临床场景时的思维过程。
实习医生通常会综合与患者问题和治疗相关的细节，无论完成任务的可用时间是否受到限制。与之前的发现相反，临床医生随后综合的信息通常与不受限制时间观察的临床事件的时间顺序以及时间受限会议的调查程序最相关。当实习医生在有和没有时间限制的情况下综合 EHR 临床记录时，遗漏错误和错误推论的平均数没有显著差异（3.5±0.5 与 2.3±0.5，p=0.14）。
我们的结果表明，在临床医生综合 EHR 临床记录时，错误的发生率不会因适度的时间限制而增加，这可能是由于从通常的时间限制的患者就诊性质中学习到的信息处理策略的有效调整。需要进一步研究类似或更极端的时间变化对不同专业水平、专业和不同护理环境下使用的认知过程的影响。
