Primary care physicians' use of an electronic medical record system: a cognitive task analysis.
OBJECTIVE
To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular.


METHODS
Cognitive task analysis using semi-structured interviews and field observations.


METHODS
Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel.


RESULTS
The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped.


CONCLUSIONS
There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.
Shachak
Aviv
A
Galil Center for Telemedicne, Medical informatics and Personalized Medicine, The R&B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. aviv.shachak@utoronto.ca
Hadas-Dayagi
Michal
M
Ziv
Amitai
A
Reis
Shmuel
S
D001292:Attitude to Computers; D015331:Cohort Studies; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011361:Professional Competence; D013647:Task Performance and Analysis