Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system. (September 2019)

• Record Type: Journal Article
• Authors: Savoy, April; Militello, Laura; Diiulio, Julie; Midboe, Amanda M.; Weiner, Michael; Abbaszadegan, Hamed; Herout, Jennifer
• Is Part Of: International journal of medical informatics. Volume 129(2019)
• Page Start: 88
• Page End: 94
• Publication Date: 2019-09
• Subjects: PCPs primary care providers -- EHR electronic health record -- HIT health information technology -- VA U.S. Department of Veterans Affairs; Referrals -- Health information technology -- Information needs -- Outpatient care -- Cognitive demand -- Referral communication; Medical informatics -- Periodicals; Information science -- Periodicals; Computers -- Periodicals; Medical technology -- Periodicals; Medical Informatics -- Periodicals; Technology, Medical -- Periodicals; Computers; Information science; Medical informatics; Medical technology; Electronic journals; Periodicals; Electronic journals; 610.285
• DOI: 10.1016/j.ijmedinf.2019.05.027
• Languages: English
• ISSNs: 1386-5056

Abstract

Highlights: Throughout the referral process, referring physicians have high cognitive demand. Our cognitive framework identifies referring physicians' information needs. EHR designs create cognitive challenges when ordering, tracking, and reviewing referrals. Referring physicians' goals, tasks, decisions, and information needs can inform EHR (re)design. Abstract: Objectives: This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs' experiences with current health information technology. Materials and methods: We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs' common experiences with health information technologies throughout the referral process. Results: The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient's Condition and Manage Referrals), and four major tasks with respective decisions ( What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists' findings ). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs. Conclusion: Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs' decision-making process and reduce cognitive challenges.