TY - JOUR
T1 - Measuring the cognitive effort associated with task switching in routine EHR-based tasks
AU - Bartek, Brian
AU - Lou, Sunny S.
AU - Kannampallil, Thomas
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/5
Y1 - 2023/5
N2 - Objective: Clinical work involves performing overlapping, time-sensitive tasks that frequently require clinicians to switch their attention between multiple tasks. We developed a methodological approach using EHR-based audit logs to determine switch costs—the cognitive burden associated with task switching—and assessed its magnitude during routine EHR-based clinical tasks. Method: Physician trainees (N = 75) participated in a longitudinal study where they provided access to their EHR-based audit logs. Physicians’ audit log actions were used to create a taxonomy of EHR tasks. These tasks were transformed into task sequences and the time spent on each task in a sequence was computed. Within these task sequences, instances of task switching (i.e., switching from one task to the next) and non-switching were identified. The primary outcome of interest was the time spent on a post-switch task. Using a mixed-effects regression model, we compared the durations of post-switch and non-switch tasks. Results: 2,781,679 audit log events over 117,822 sessions from 75 physicians were analyzed. Physicians spent most time on chart review (Median (IQR) = 5,439 (2,492–8,336) seconds), note review (1,936 (827–3,321) seconds), and navigating the EHR interface (1,048 (365.5–2,006) seconds) daily. Post task switch activity times were greater for documentation (Median increase = 5 s), order entry (Median increase = 3 s) and results review (Median increase = 3 s). Mixed-effects regression showed that time spent on tasks were longer following a task switch (β = 0.03; 95% CIlower = 0.027, CIupper = 0.034), with greater post-swtich task times for imaging, order entry, note review, handoff, note entry, chart review and best practice advisory tasks. Discussion: Increased task switching time—an indicator of the cognitive burden associated with switching between tasks—is prevalent in routine EHR-based tasks. We discuss the cumulative impact of incremental switch costs have on overall EHR workload, wellness, and error rates. Relying on theoretical cognitive foundations, we suggest pragmatic design considerations for mitigating the effects of cognitive burden associated with task switching.
AB - Objective: Clinical work involves performing overlapping, time-sensitive tasks that frequently require clinicians to switch their attention between multiple tasks. We developed a methodological approach using EHR-based audit logs to determine switch costs—the cognitive burden associated with task switching—and assessed its magnitude during routine EHR-based clinical tasks. Method: Physician trainees (N = 75) participated in a longitudinal study where they provided access to their EHR-based audit logs. Physicians’ audit log actions were used to create a taxonomy of EHR tasks. These tasks were transformed into task sequences and the time spent on each task in a sequence was computed. Within these task sequences, instances of task switching (i.e., switching from one task to the next) and non-switching were identified. The primary outcome of interest was the time spent on a post-switch task. Using a mixed-effects regression model, we compared the durations of post-switch and non-switch tasks. Results: 2,781,679 audit log events over 117,822 sessions from 75 physicians were analyzed. Physicians spent most time on chart review (Median (IQR) = 5,439 (2,492–8,336) seconds), note review (1,936 (827–3,321) seconds), and navigating the EHR interface (1,048 (365.5–2,006) seconds) daily. Post task switch activity times were greater for documentation (Median increase = 5 s), order entry (Median increase = 3 s) and results review (Median increase = 3 s). Mixed-effects regression showed that time spent on tasks were longer following a task switch (β = 0.03; 95% CIlower = 0.027, CIupper = 0.034), with greater post-swtich task times for imaging, order entry, note review, handoff, note entry, chart review and best practice advisory tasks. Discussion: Increased task switching time—an indicator of the cognitive burden associated with switching between tasks—is prevalent in routine EHR-based tasks. We discuss the cumulative impact of incremental switch costs have on overall EHR workload, wellness, and error rates. Relying on theoretical cognitive foundations, we suggest pragmatic design considerations for mitigating the effects of cognitive burden associated with task switching.
KW - Cognitive burden
KW - Cognitive science
KW - EHR audit logs
KW - Switch costs
KW - Task switching
UR - http://www.scopus.com/inward/record.url?scp=85159554383&partnerID=8YFLogxK
U2 - 10.1016/j.jbi.2023.104349
DO - 10.1016/j.jbi.2023.104349
M3 - Article
C2 - 37015304
AN - SCOPUS:85159554383
SN - 1532-0464
VL - 141
JO - Journal of Biomedical Informatics
JF - Journal of Biomedical Informatics
M1 - 104349
ER -