Abstract
Electronic health records (EHRs) in emergency departments (EDs) store and display important medical information and thus play a critical role in medical diagnoses. However, current EHR designs often result in display clutter, a condition where a large amount of poorly organized information is displayed. This can cause delays in finding and noticing relevant information. Clutter may be especially problematic under conditions of stress, which is known to degrade people’s perceptual capacities. The goal of this study was to analyze the effects of EHR clutter and stress on physicians’ ability to search for and notice important information during medical diagnosis procedures. Three simulated EHR pages were developed for this study. Participating physicians were presented with typical ED patient scenarios and the relevant EHR page for each patient. They were required to search the EHR displays to answer a specific question related to each patient and, based on their review of the EHR, they had to confirm or refute a proposed diagnosis. Performance measures and subjective feedback were collected. In general, results showed that clutter increased the time to find a given search target and the time to extract important information, as well as the number of missed targets. The effects of clutter were most pronounced for the EHR page that displayed unorganized lists of medical data, where the presence of stress also exacerbated the effects of clutter on response time. These results emphasize the need to develop display countermeasures to overcome the effects of display clutter in hospital as well as other environments.
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