Wilbanks Bryan A, McMullan Susan P
Author Affiliation: The University of Alabama at Birmingham School of Nursing.
Comput Inform Nurs. 2018 Dec;36(12):579-588. doi: 10.1097/CIN.0000000000000469.
The To Err Is Human report stated that 98 000 patients die yearly because of medical errors, and that medication errors kill more people than workplace injuries. The inadequate design and utilization of the electronic health record have been identified as major contributing factors to medical errors. Increased cognitive workload of clinicians has consistently been linked to the occurrence of medical errors. The purpose of this article was to synthesize the current state of the science on measuring clinicians' cognitive workload associated with using electronic health records in order to inform evidence-based guidelines. The major considerations identified in the literature involve the use of psychometric instruments, using efficiency as a proxy for cognitive workload, and eye tracking. The National Aeronautics and Space Administration Task Load Index was the most used psychometric instrument, but reliability measures were not reported. It is important to evaluate reliability of psychometric instruments because the consistency of the instrument can change when administered to different populations. Efficiency is an observable measure defined by the total time to complete a task and the total number of physical interactions with the user interface. Efficiency can allow the use of statistical modeling, but it does not directly evaluate the mental activity associated with using an electronic health record interface. Eye tracking has been used extensively in the literature to measure cognitive workload via changes in pupil size related to mental activity, but it is not often used to measure the cognitive workload associated with using the electronic health record. Eye tracking is very useful for continuous monitoring of cognitive workload.
《人皆会犯错》报告指出，每年有9.8万名患者因医疗差错死亡，且用药差错导致的死亡人数超过工作场所受伤致死人数。电子健康记录的设计不完善及使用不当已被认定为医疗差错的主要促成因素。临床医生认知工作量的增加一直与医疗差错的发生有关。本文的目的是综合当前关于测量临床医生与使用电子健康记录相关的认知工作量的科学现状，以便为循证指南提供依据。文献中确定的主要考量因素包括心理测量工具的使用、将效率作为认知工作量的替代指标以及眼动追踪。美国国家航空航天局任务负荷指数是使用最多的心理测量工具，但未报告可靠性测量结果。评估心理测量工具的可靠性很重要，因为当应用于不同人群时，该工具的一致性可能会发生变化。效率是一种可观察的指标，由完成一项任务的总时间以及与用户界面的物理交互总数来定义。效率可以允许使用统计建模，但它并不能直接评估与使用电子健康记录界面相关的心理活动。眼动追踪在文献中已被广泛用于通过与心理活动相关的瞳孔大小变化来测量认知工作量，但它并不常用于测量与使用电子健康记录相关的认知工作量。眼动追踪对于持续监测认知工作量非常有用。
