Task analysis of writing hospital admission orders: evidence of a problem-based approach.
As part of a broader project to improve the usability of computerized physician order entry (CPOE)systems, we set out to study the cognitive tasks physicians undertake to write "admission orders" when admitting a patient to the hospital. In particular, we evaluate the hypothesis that physicians' mental model of diagnostic and therapeutic planning is problem based, whereas both paper-based ordering and CPOE are typically organized around functional categories of orders such as those reflected in the mnemonic ADCVAANDIML. A task analysis was performed which included think-aloud observations of physicians writing orders in clinical care settings and for fictional case-scenarios, as well as a semistructured questionnaire. Our work finds core tasks of admitting a patient to hospital and conflicts between physicians' mental model and traditional ordering systems. Based on our study, we suggest improvements to traditional CPOE systems.
Johnson
Christopher D
CD
Stanford Biomedical Informatics, Stanford University, Stanford, CA, USA.
Zeiger
Roni F
RF
Das
Amar K
AK
Goldstein
Mary K
MK
D006801:Humans; D050316:Medical Order Entry Systems; D008606:Mental Processes; D010343:Patient Admission / Q000706:statistics & numerical data; D010347:Patient Care Planning; D010820:Physicians / Q000523:psychology*; D013647:Task Performance and Analysis