Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 27, 2025
Date Accepted: Jul 16, 2025
Investigating Information Visualization to Combat Information Overload in Electronic Health Records: Protocol for a Randomized Controlled Trial
ABSTRACT
Background:
Electronic health records (EHRs) have been linked to information overload, which can lead to cognitive fatigue, a precursor to burnout. This can cause healthcare providers to miss critical information, make clinical errors, and lead to delays in care delivery. This challenge is particularly pronounced in medical intensive care units (ICUs), where patients are critically ill and their EHRs contain extensive and complex data.
Objective:
We propose to study the relationship between cognitive fatigue and EHR use among medical ICU providers in four major United States medical centers. In this Randomized Controlled Trial (RCT), we will compare two leading EHRs with a visualization dashboard-based EHR, AWARE™.
Methods:
This study will collect physiological and objective data using a screen-mounted eye-tracking device to assess cognitive fatigue among ICU providers interacting with EHRs. We aim to evaluate EHR usability and its impact on clinical decision-making by analyzing eye-tracking metrics alongside performance measures and validated surveys. Primary outcomes include: the number of cognitive fatigue instances per patient case, time to complete each case and the overall usability session, number of mouse clicks per case, provider performance scores from questions asked during each patient case, and perceived usability of each EHR system (System Usability Questionnaire scores). Secondary outcomes include: the number of eye fixations per patient case and perceived workload of each EHR system (NASA Task Load Index scores).
Results:
This EHR usability study was funded in 2021. The study was initiated in 2022 with a completion date of 2025. Data collection began in August 2023 and is expected to finish in April 2025.
Conclusions:
This study aims to characterize cognitive fatigue experienced by ICU providers during EHR use. Through a randomized controlled trial, we will evaluate EHR usability across multiple medical centers, comparing providers’ institutional EHR systems (control) with a visualization dashboard-based EHR (intervention). Findings from this research may inform improvements in EHR interface design and usability, which may enhance provider performance, streamline care delivery, and improve patient safety outcomes. Clinical Trial: NCT05937646
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.