On the EHR-related term "cognitive overload"

I often use the term "cognitive overload" when writing about EHR and related information technology systems that present a needlessly complex user experience to clinicians.  This affects the care they deliver in negative ways.

Physicians and nurses are presented with too much complexity for the hard, fast, unpredictable work they have to perform.

This picture of a B36J cockpit illustrates the concept of cognitive overload instantly:

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A 360-degree "virtual tour" is at http://www.nmusafvirtualtour.com/media/062/B-36J%20Engineer.htm.  Scroll around the cockpit to see more.

Any questions?

-- SS

EHR Pastel Madness: Cognitive Overload in Critical Care

It's hard to find public postings that show the crazy and dangerous complexity of EHR interfaces, but I found a presentation at http://www.uiowa.edu/~medtest2/picis/vo_picis.pdf (PDF slide presentation) that demonstrates ths problem well.

These are from a 2006 training presentation on an EHR for Critical Care , where doctors and nurses really don't have the time to wade through complexity like this.   

I can honestly and in fact, with great vigor, opine I would not have wanted to use a tool like this when I was working in intensive care units.  And I'm a Medical Informatics specialist x 21 years...


EHRs have not changed much; in fact with the higher commodity (cheap) screen resolutions available in 2013 compared to 2006, the problem is worse.

Some sample screens:

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And there's more where these came from at the link above.

Insane, in my view, to subject busy, stressed out clinicians to a pastel nightmare like this. 

(And that's assuming the application doesn't lose or corrupt data.)

This is not to single out this particular seller.  Other EHR sellers' products are similarly visually and operationally complex.

But, if you, the reader, like these and think, the more that can be packed in the merrier, bring it on, that's fine with me.  It's your life and limb.

Actually, not - because my life and limb are at risk, too.

See the entire presentation for more.

-- SS

An MD hospitalist on EHR's: I might have inadvertently skipped something during the mayhem

At "Clinicians Going for a Swim and Drowning in Information" I commented on a NY Times article about how information and cognitive overload can lead to deadly consequences in warfare. My implication was that medical care (e.g., the ED) bears some similarities.

I received this reply from a clinician hospitalist I know, who also is well versed in Medical Informatics:

Wow, great piece, but a little too close to home for me right now.

Eerily similar to / descriptive of my experience last night in the hospital: processing multiple information sources related to multiple different problems for a new admission (patient, family, ED staff, disjointed EMR - some documents in the Documents tab of the [major EHR vendor name redacted - ed.] system but most others in the hospital system Portal requiring a separate lookup, some radiology studies available through the EMR on any workstation but others requiring accessing the PACS system directly on scarcer dedicated workstations - plus paper record components, including EKGs, progress notes) ... all while various drone-equivalents are channeling information regarding multiple other admissions in the wings and/or patients decompensating on the floors or in the ICU.

Oh yeah, and then there's the "12 hour shift" thing. Oops, gotta run... Just slept all day after my night shift and have to head back to hospital for the next one. Still haven't submitted any charge tickets, btw, even for last week's shifts (I'm carrying around paper face sheets with scribbled notes on the back; I'm supposed to fax them to the billing office once I figure out what CPT / visit intensity code I want to use.)

Gosh, I hope I remembered to touch on 10 bullet points related to ten organ systems for my ROS for each of my admissions; might have inadvertently skipped something during the mayhem...

PS. I'd love to be wearing one of those brain wave contraptions mentioned in the article to see what my theta wave activity was.

This is not atypical of IT's effects on healthcare today.

-- SS

Clinicians Going for a Swim and Drowning in Information

Clinicians these days at computerized facilities are often drinking information from a firehose, and even worse.

Just to make their tasks more difficult, the firehose is difficult to use, it sputters on occasion due to "glitches" in the water pumps, and sometimes even emits fouled water due to problems at the reservoir or connecting pipes, without frequent "workarounds" and mental gymnastics by the clinicians. I've seen it personally in the care of relatives.

This is far from the dream of Medical Informatics, whose specialists viewed IT as a tool to reduce cognitive overload and make healthcare provision more efficient.

Why is information overload a bad thing?

Here's why:

New York Times
In New Military, Data Overload Can Be Deadly
By THOM SHANKER and MATT RICHTEL
January 16, 2011

When military investigators looked into an attack by American helicopters last February that left 23 Afghan civilians dead, they found that the operator of a Predator drone had failed to pass along crucial information about the makeup of a gathering crowd of villagers.

But Air Force and Army officials now say there was also an underlying cause for that mistake: information overload.

At an Air Force base in Nevada, the drone operator and his team struggled to work out what was happening in the village, where a convoy was forming. They had to monitor the drone’s video feeds while participating in dozens of instant-message and radio exchanges with intelligence analysts and troops on the ground.

There were solid reports that the group included children, but the team did not adequately focus on them amid the swirl of data — much like a cubicle worker who loses track of an important e-mail under the mounting pile. The team was under intense pressure to protect American forces nearby, and in the end it determined, incorrectly, that the villagers’ convoy posed an imminent threat, resulting in one of the worst losses of civilian lives in the war in Afghanistan.

“Information overload — an accurate description,” said one senior military officer, who was briefed on the inquiry and spoke on the condition of anonymity because the case might yet result in a court martial. The deaths would have been prevented, he said, “if we had just slowed things down and thought deliberately.”

Data is among the most potent weapons of the 21st century. Unprecedented amounts of raw information help the military determine what targets to hit and what to avoid. And drone-based sensors have given rise to a new class of wired warriors who must filter the information sea. But sometimes they are drowning.

Research shows that the kind of intense multitasking required in such situations can make it hard to tell good information from bad. The military faces a balancing act: how to help soldiers exploit masses of data without succumbing to overload.

Read the entire NY Times piece.

I have no other comments to offer, other than (as the military seems to recognize for its own needs through engaging experts in domains such as neuroscience), the time to "accelerate interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering" as recommended in 2009 by the National Research Council is before the attempted national rollout of hundreds of billions of dollars of technology.

The time to do so is not during - and certainly not after - the HITECH-led medical re-engineering attempt.

Finally, unlike the health IT industry, I don't see the military attributing these issues to "Luddite soldiers."

-- SS