RESUMEN
The goal of this study was to elicit the cognitive demands facing clinicians when using an electronic health record (EHR) system and learn the cues and strategies expert clinicians rely on to manage those demands. This study differs from prior research by applying a joint cognitive systems perspective to examining the cognitive aspects of clinical work. We used a cognitive task analysis (CTA) method specifically tailored to elicit the cognitive demands of an EHR system from expert clinicians from different sites in a variety of inpatient and outpatient roles. The analysis of the interviews revealed 145 unique cognitive demands of using an EHR, which were organized into 22 distinct themes across seven broad categories. In addition to confirming previously published themes of cognitive demands, the main emergent themes of this study are: 1) The EHR does not help clinicians develop and maintain awareness of the big picture; 2) The EHR does not support clinicians' need to reason about patients' current and future states, including effects of potential treatments; and 3) The EHR limits agency of clinicians to work individually and collaboratively. Implications for theory and EHR design and evaluation are discussed.