A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment
- Affiliations of the authors: Geriatric Research, Education, and Clinical Center (GRECC) and Salt Lake Informatics, Decision Enhancement and Surveillance (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center (CRW, BLH, JN), Salt Lake City, UT; Departments of Bio-Medical Informatics (CRW), Internal Medicine (JN), Psychology (RC, FD), College of Nursing (BL), University of Utah, Salt Lake City, UT
- Correspondence and reprints: Charlene Weir, PhD, Geriatric Research, Education, and Clinical Center (182), George E. Wahlen Department of Veterans Affairs Medical Center, 500 Foothill Dr., Salt Lake City, UT 84148; Tel: (801) 582-1565; Fax: (801) 584-5640; e-mail: <weir{at}va.gov>
- Received 31 July 2006
- Accepted 13 October 2006
Abstract
Objective Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques.
Design Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers.
Measurements Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified.
Results Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented.
Conclusion Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.
Footnotes
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This study was supported by VA HSR&D # MRC 03-237, TRP 02-147-2 and RCD 02-176-2.
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The authors acknowledge the help and support of Hank Rappaport, MD at the Office of Information, Veterans Health Administration, Department of Veterans Affairs. Dr. Rappaport provided important insight into the VA system development.
