Abstract
BackgroundUse of electronic health records (EHRs) has increased dramatically over the past decade. Their widespread adoption has been plagued with numerous complaints about usability, with subsequent impacts on patient safety and provider well-being. Data in other fields suggest biological sex impacts basic patterns of navigation in electronic media.ObjectiveThis study aimed to determine whether biological sex impacted physicians’ navigational strategies while using EHRs.MethodsThis is a secondary analysis of a prior study where physicians were given verbal and written signout, and then, while being monitored with an eye tracker, were asked to review a simulated record in our institution’s EHR system, which contained 14 patient safety items. Afterward, the number of safety items recognized was recorded.ResultsA total of 93 physicians (female: n=46, male: n=47) participated in the study. Two gaze patterns were identified: one characterized more so by saccadic (“scanning”) eye movements and the other characterized more so by longer fixations (“staring”). Female physicians were more likely to use the scanning pattern; they had a shorter mean fixation duration (P=.005), traveled more distance per minute of screen time (P=.03), had more saccades per minute of screen time (P=.02), and had longer periods of saccadic movement (P=.03). The average proportion of time spent staring compared to scanning (the Gaze Index [GI]) across all participants was approximately 3:1. Females were more likely than males to have a GI value <3.0 (P=.003). At the extremes, males were more likely to have a GI value >5, while females were more likely to have a GI value <1. Differences in navigational strategy had no impact on task performance.ConclusionsFemales and males demonstrate fundamentally different navigational strategies while navigating the EHR. This has potentially significant impacts for usability testing in EHR training and design. Further studies are needed to determine if the detected differences in gaze patterns produce meaningful differences in cognitive load while using EHRs.
Highlights
In the last two decades, the percentage of physicians using an electronic health record (EHR) in their practice has risen from around 10% to over 80%, driven in varying degrees by federal initiatives, intra- and internetwork pressure, and perceived potential advantages
This is a secondary analysis of a prior study where physicians were given verbal and written signout, and while being monitored with an eye tracker, were asked to review a simulated record in our institution’s EHR system, which contained 14 patient safety items
We have previously reported the use of high-fidelity EHR-based simulation to understand error recognition in simulated intensive care unit (ICU) charts [28,31,32,33]
Summary
In the last two decades, the percentage of physicians using an electronic health record (EHR) in their practice has risen from around 10% to over 80%, driven in varying degrees by federal initiatives, intra- and internetwork pressure, and perceived potential advantages. This increase represents a broad shift in practice patterns that have introduced new challenges into the process of delivering quality medical care. Use of electronic health records (EHRs) has increased dramatically over the past decade Their widespread adoption has been plagued with numerous complaints about usability, with subsequent impacts on patient safety and provider well-being. Data in other fields suggest biological sex impacts basic patterns of navigation in electronic media
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