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The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance*

Ahmed, Adil MBBS; Chandra, Subhash MBBS; Herasevich, Vitaly MD, PhD; Gajic, Ognjen MD, THDCC; Pickering, Brian W. MB, BCh (Anes)

doi: 10.1097/CCM.0b013e31821858a0
Clinical Investigations

Objectives: The care of critically ill patients generates large quantities of data. Increasingly, these data are presented to the provider within an electronic medical record. The manner in which data are organized and presented can impact on the ability of users to synthesis that data into meaningful information. The objective of this study was to test the hypothesis that novel user interfaces, which prioritize the display of high-value data to providers within system-based packages, reduce task load, and result in fewer errors of cognition compared with established user interfaces that do not.

Design: Randomized crossover study.

Setting: Academic tertiary referral center.

Subjects: Attending, resident and fellow critical care physicians.

Interventions: Novel health care record user interface.

Measurement: Subjects randomly assigned to either a standard electronic medical record or a novel user interface, were asked to perform a structured task. The task required the subjects to use the assigned electronic environment to review the medical record of an intensive care unit patient said to be actively bleeding for data that formed the basis of answers to clinical questions posed in the form of a structured questionnaire. The primary outcome was task load, measured using the paper version of the NASA-task load index. Secondary outcome measures included time to task completion, number of errors of cognition measured by comparison of subject to post hoc gold standard questionnaire responses, and the quantity of information presented to subjects by each environment.

Main Results: Twenty subjects completed the task on eight patients, resulting in 160 patient–provider encounters (80 in each group). The standard electronic medical record contained a much larger data volume with a median (interquartile range) number of data points per patient of 1008 (895–1183) compared with 102 (77–112) contained within the novel user interface. The median (interquartile range) NASA-task load index values were 38.8 (32–45) and 58 (45–65) for the novel user interface compared with the standard electronic medical record (p < .001). The median (interquartile range) times in seconds taken to complete the task for four consecutive patients were 93 (57–132), 60 (48–71), 68 (48–80), and 54 (42–64) for the novel user interface compared with 145 (109–201), 125 (113–162), 129 (100–145), and 112 (92–123) for the standard interface (p < .0001), respectively. The median (interquartile range) number of errors per provider was 0.5 (0–1) and two (0.25–3) for the novel user interface and standard electronic medical record interface, respectively (p = .007).

Conclusions: A novel user interface was designed based on the information needs of intensive care unit providers with a specific goal of development being the reduction of task load and errors of cognition associated with filtering, extracting, and using medical data contained within a comprehensive electronic medical record. The results of this simulated clinical experiment suggest that the configuration of the intensive care unit user interface contributes significantly to the task load, time to task completion, and number of errors of cognition associated with the identification, and subsequent use, of relevant patient data. Task-specific user interfaces, developed from an understanding of provider information requirements, offer advantages over interfaces currently available within a standard electronic medical record.


From the Department of Anesthesiology (BWP), Division of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; the Department of Internal Medicine (VH, OG), Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN; and Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) (AA, SC, VH, OG, BWP), Mayo Clinic College of Medicine, Rochester, MN.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's web site ( Supplemental Table 1 can be accessed through this link (see Supplemental Digital Content 1,

Drs. Herasevich, Gajic, and Pickering have a pending patent on a novel user interface displayed in Figure 1B. The remaining authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins