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电子健康记录的使用对临床医生认知负荷和职业倦怠的影响:叙述性综述

Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review.

作者信息

Asgari Elham, Kaur Japsimar, Nuredini Gani, Balloch Jasmine, Taylor Andrew M, Sebire Neil, Robinson Robert, Peters Catherine, Sridharan Shankar, Pimenta Dominic

机构信息

Guy's and St Thomas' NHS Trust, London, United Kingdom.

Tortus AI, London, United Kingdom.

出版信息

JMIR Med Inform. 2024 Apr 12;12:e55499. doi: 10.2196/55499.

Abstract

The cognitive load theory suggests that completing a task relies on the interplay between sensory input, working memory, and long-term memory. Cognitive overload occurs when the working memory's limited capacity is exceeded due to excessive information processing. In health care, clinicians face increasing cognitive load as the complexity of patient care has risen, leading to potential burnout. Electronic health records (EHRs) have become a common feature in modern health care, offering improved access to data and the ability to provide better patient care. They have been added to the electronic ecosystem alongside emails and other resources, such as guidelines and literature searches. Concerns have arisen in recent years that despite many benefits, the use of EHRs may lead to cognitive overload, which can impact the performance and well-being of clinicians. We aimed to review the impact of EHR use on cognitive load and how it correlates with physician burnout. Additionally, we wanted to identify potential strategies recommended in the literature that could be implemented to decrease the cognitive burden associated with the use of EHRs, with the goal of reducing clinician burnout. Using a comprehensive literature review on the topic, we have explored the link between EHR use, cognitive load, and burnout among health care professionals. We have also noted key factors that can help reduce EHR-related cognitive load, which may help reduce clinician burnout. The research findings suggest that inadequate efforts to present large amounts of clinical data to users in a manner that allows the user to control the cognitive burden in the EHR and the complexity of the user interfaces, thus adding more "work" to tasks, can lead to cognitive overload and burnout; this calls for strategies to mitigate these effects. Several factors, such as the presentation of information in the EHR, the specialty, the health care setting, and the time spent completing documentation and navigating systems, can contribute to this excess cognitive load and result in burnout. Potential strategies to mitigate this might include improving user interfaces, streamlining information, and reducing documentation burden requirements for clinicians. New technologies may facilitate these strategies. The review highlights the importance of addressing cognitive overload as one of the unintended consequences of EHR adoption and potential strategies for mitigation, identifying gaps in the current literature that require further exploration.

摘要

认知负荷理论表明,完成一项任务依赖于感觉输入、工作记忆和长期记忆之间的相互作用。当由于信息处理过多而超出工作记忆的有限容量时,就会发生认知过载。在医疗保健领域,随着患者护理的复杂性增加,临床医生面临的认知负荷也在增加,这可能导致职业倦怠。电子健康记录(EHR)已成为现代医疗保健的一个常见特征,它提供了更好的数据访问能力,并有助于提供更好的患者护理。它们与电子邮件和其他资源(如指南和文献检索)一起被添加到电子生态系统中。近年来,人们担心尽管电子健康记录有许多好处,但使用它可能会导致认知过载,进而影响临床医生的工作表现和身心健康。我们旨在综述使用电子健康记录对认知负荷的影响,以及它与医生职业倦怠之间的关联。此外,我们希望确定文献中推荐的潜在策略,这些策略可以用来减轻与使用电子健康记录相关的认知负担,以减少临床医生的职业倦怠。通过对该主题进行全面的文献综述,我们探讨了医疗保健专业人员使用电子健康记录、认知负荷和职业倦怠之间的联系。我们还指出了有助于减少与电子健康记录相关的认知负荷的关键因素,这可能有助于减少临床医生的职业倦怠。研究结果表明,在以一种让用户能够控制电子健康记录中的认知负担以及用户界面复杂性的方式向用户呈现大量临床数据方面,努力不足,从而给任务增加了更多“工作量”,可能会导致认知过载和职业倦怠;这就需要采取策略来减轻这些影响。电子健康记录中信息的呈现方式、专业领域、医疗保健环境以及完成文档编制和操作系统所花费的时间等几个因素,都可能导致这种过度的认知负荷,并导致职业倦怠。减轻这种情况可能的潜在策略包括改善用户界面、简化信息以及减少临床医生的文档编制负担要求。新技术可能会促进这些策略的实施。该综述强调了解决认知过载问题的重要性,认知过载是采用电子健康记录的意外后果之一,同时强调了潜在的缓解策略,指出了当前文献中需要进一步探索的空白。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a625/11053390/3f68a5abd6ce/medinform_v12i1e55499_fig1.jpg

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