JMIR Publications

ABSTRACT

Background:

Electronic Health Records (EHR) use 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.

Objective:

To determine whether biological sex impacted physicians’ navigational strategies while using the EHR.

Methods:

Ninety-three Physicians (46 female, 47 male) participated. They were given verbal and written signout and then, while being monitored with an eye tracker, asked to review a simulated record in our institution’s EHR which contained 14 patient safety items. Afterward, the number of safety items recognized was recorded.

Results:

Two gaze patterns were identifiable: 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=0.005), traveled more distance per minute of screen time (p=0.03), had more saccades per minute of screen time (p=0.02), and had longer periods of saccadic movement (p=0.03).The average proportion of time spent staring compared to scanning (Gaze Index; GI) across all participants was approximately 3:1. Females were more likely than males to have a GI<3.0 (p=0.003). At the extremes, males were more likely to have a GI>5 while females were more likely to have a GI<1. Differences in navigational strategy had no impact in task performance.

Conclusions:

Females 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 study is needed to determine if the detected differences in gaze patterns produce meaningful differences in cognitive load while using EHRs.