Colligan Lacey, Potts Henry W W, Finn Chelsea T, Sinkin Robert A
Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.
Centre for Health Informatics & Multiprofessional Education (CHIME), University College London, London, UK.
Int J Med Inform. 2015 Jul;84(7):469-76. doi: 10.1016/j.ijmedinf.2015.03.003. Epub 2015 Mar 22.
Healthcare institutions worldwide are moving to electronic health records (EHRs). These transitions are particularly numerous in the US where healthcare systems are purchasing and implementing commercial EHRs to fulfill federal requirements. Despite the central role of EHRs to workflow, the cognitive impact of these transitions on the workforce has not been widely studied. This study assesses the changes in cognitive workload among pediatric nurses during data entry and retrieval tasks during transition from a hybrid electronic and paper information system to a commercial EHR.
Baseline demographics and computer attitude and skills scores were obtained from 74 pediatric nurses in two wards. They also completed an established and validated instrument, the NASA-TLX, that is designed to measure cognitive workload; this instrument was used to evaluate cognitive workload of data entry and retrieval. The NASA-TLX was administered at baseline (pre-implementation), 1, 5 and 10 shifts and 4 months post-implementation of the new EHR.
Most nurse participants experienced significant increases of cognitive workload at 1 and 5 shifts after "go-live". These increases abated at differing rates predicted by participants' computer attitudes scores (p = 0.01).
There is substantially increased cognitive workload for nurses during the early phases (1-5 shifts) of EHR transitions. Health systems should anticipate variability across workers adapting to "meaningful use" EHRs. "One-size-fits-all" training strategies may not be suitable and longer periods of technical support may be necessary for some workers.
全球医疗机构都在转向电子健康记录（EHR）。在美国，这种转变尤为普遍，医疗系统正在购买和实施商业EHR以满足联邦要求。尽管EHR在工作流程中起着核心作用，但这些转变对员工认知的影响尚未得到广泛研究。本研究评估了儿科护士在从混合电子和纸质信息系统过渡到商业EHR期间，在数据录入和检索任务中的认知工作量变化。
从两个病房的74名儿科护士那里获取了基线人口统计学数据以及计算机态度和技能得分。他们还完成了一种既定且经过验证的工具——NASA-TLX，该工具旨在测量认知工作量；此工具用于评估数据录入和检索的认知工作量。NASA-TLX在基线（实施前）、新EHR实施后的第1、5和10个班次以及实施后4个月进行了管理。
大多数护士参与者在“上线”后的第1和第5个班次经历了认知工作量的显著增加。这些增加以参与者的计算机态度得分所预测的不同速率有所减轻（p = 0.01）。
在EHR过渡的早期阶段（1 - 5个班次），护士的认知工作量大幅增加。卫生系统应预计到员工在适应“有意义使用”EHR方面存在差异。“一刀切”的培训策略可能不合适，对于一些员工可能需要更长时间的技术支持。
