Analysis of the cognitive demands of electronic health record use.

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.

Negative affect reduces team awareness: the effects of mood and stress on computer-mediated team communication.

OBJECTIVE: This article presents research on the effects of varying mood and stress states on within-team communication in a simulated crisis management environment, with a focus on the relationship between communication behaviors and team awareness. BACKGROUND: Communication plays a critical role in team cognition along with cognitive factors such as attention, memory, and decision-making speed. Mood and stress are known to have interrelated effects on cognition at the individual level, but there is relatively little joint exploration of these factors in team communication in technologically complex environments. METHOD: Dyadic communication behaviors in a distributed six-person crisis management simulation were analyzed in a factorial design for effects of two levels of mood (happy, sad) and the presence or absence of a time pressure stressor. RESULTS: Time pressure and mood showed several specific impacts on communication behaviors. Communication quantity and efficiency increased under time pressure, though frequent requests for information were associated with poor performance. Teams in happy moods showed enhanced team awareness, as revealed by more anticipatory communication patterns and more detailed verbal responses to teammates than those in sad moods. CONCLUSION: Results show that the attention-narrowing effects of mood and stress associated with individual cognitive functions demonstrate analogous impacts on team awareness and information-sharing behaviors and reveal a richer understanding of how team dynamics change under adverse conditions. APPLICATION: Disentangling stress from mood affords the opportunity to target more specific interventions that better support team awareness and task performance.