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Research
Projects
Cognition and Human-Computer Interaction
Interaction with Provider
Order Entry Systems: Methodology for the evaluation of cognitive complexity
Funded by NLM Fellowship to Jan Horsky.
The process of computer-based clinical ordering is
frequently made excessively cognitively demanding by poorly designed interfaces.
We are developing methodology to characterize the sources of unnecessary
cognitive complexity of the interface. Specifically, we investigate the
interaction of clinicians with a complex provider order entry system (CPOE)
using theoretical foundations from cognitive science and an explanatory framework
based on the theory of distributed cognition. The goal is to characterize the
nature of cognitive demands imposed by the interaction and its effects on
usability, user performance and medical error. Overly complex or inconvenient
interfaces that are difficult to navigate claim a disproportionate share of human
limited working memory resources. In effect, they divert focus away from the
main clinical task and delay its completion. Well designed interfaces allow
users to focus primarily on higher-order cognitive activity, such as clinical
reasoning and treatment planning. Also, making the ordering process fit better
into established workflow routines may help overcoming the frequently strong
initial opposition of clinicians to CPOE and smooth the progress of
large-scale implementation of this safety-enhancing technology in US
hospitals.
(Jan Horsky, David Kaufman and Vimla
Patel)
Comprehensive methodology for the analysis of cognitive errors in a complex interaction among human and computer agents
(Funded by NLM. PI: Vimla L. Patel)
Many serious medication errors involving complex clinical information systems require a comprehensive approach to the analysis of failures in the interaction
between humans and information technology. We have developed a novel approach to analyze a specific case of a dosing error related to computer-based (CPOE)
ordering of potassium chloride (KCl). Our method included a chronological reconstruction of events and their interdependencies from provider order entry usage
logs, semi-structured interviews with involved clinicians and interface usability inspection of the ordering system. Information collected from all sources
were compared and evaluated to understand how the error evolved and propagated through the system. In this case, we found that the error was the product of
faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. We characterized
errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training
problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of our analysis were used to formulate specific
recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps
of the KCl ordering process to reduce the risk of future medication dosing errors. (Jan Horsky, Gillard Kuperman and Vimla Patel)
(Jan Horsky, Gillard Kuperman and Vimla Patel))
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