While we were fortunate enough to be able to speak to various physicians (and on two occasions, even in the context of their practice), we found a wealth of knowledge through conducting extensive literature reviews, engaging with subject matter experts, and even attending a conference in New Orleans focused on Human Factors and Ergonomics in Healthcare.
Our focus during early stages of research centered around how physicians themselves described burnout, how often they felt burnt out, what they felt contributed to burnout, and the extent to which digital tools either helped or hindered their workflow.
We read over 60 academic papers related to EMR software, physician burnout, and human factors considerations surrounding physicians' workflow. Special attention was paid to issues of cognitive processing, visual-sensory research, information foraging, and capacity of working memory.
Before conducting any scheduled, formal interviews, we wanted to get a rough understanding of physician’s perspectives regarding burnout. We conducted 8 ‘guerilla’ interviews with physicians leaving shifts outside of the University of Pittsburgh Medical Center (UPMC).
We spoke with 18 subject matter experts, ranging from current designers at health-tech companies to human factors engineers responsible for the development of medical devices.
We conducted 2 contextual inquiries with local, Pittsburgh-based physicians to see first-hand the day-to-day tasks and responsibilities of primary care physicians.
We conducted 11 hour-long, semi-structured interviews with physicians working across the United States.
We attended the annual Human Factors and Ergonomics Society's (HFES) Symposium focused specifically on healthcare technology, where we had the opportunity to engage in numerous workshops, sit in on presentation sessions, and network with professionals in the healthcare space.
Contributors to Cognitive Load:
Directing Attention
Decision-Making
Sorting Info
Task-Switching
Maintaining Goals
Working Memory
Emotion Regulation
Interruptions
* A presentation by design researcher Kate MacNamee at the 2022 HFES Symposium was instrumental to our understanding of contributors to cognitive load.
01
Timing of data entry is a tradeoff for physicians
The abundance of manual data entry forces physicians to weigh tradeoffs in their time; they can either rely on recall, charting after work hours and during breaks, or task switch and undermine patient interaction by charting during the patient exam.
Task-Switching
Recall
02
Finding missing patient information takes multiple steps
A lack of interoperability causes physicians to miss critical information about patient history. This requires added effort to search in a remote system for this information or rely on patients to share.
Task-Switching
Interruptions
03
Making diagnoses requires sifting through data
Poor information architecture requires physicians to sift through multiple layers of patient data to find relevant information needed to identify trends, make accurate diagnoses, and finalize charting.
Attention
Sorting Info
04
Inundation of alerts leads to fatigue
The lack of information hierarchy in EMR inbox and constant stream of alerts—tasks, results, messages—puts added mental load on physicians to keep track of tasks, direct attention to high priority alerts, and focus amid distractions.
Attention
Interruptions
Task-Switching
05
Basic Tasks Require Multiple Clicks
Clunky EMR navigation requires ample amounts of searching to input basic information in the patient chart. This requires multiple clicks and extends the time it takes to navigate between pages of patient history and building progress notes.
Attention
Memory Recall
06
Mental models of ICD codes are mismatched
A disconnect exists between how physicians define certain diagnoses and what ICD-10 codes actually mean, leading to time-consuming, confusing code selection processes. A poor understanding of where ICD codes fall in HCC blocks complicates reimbursements.
Memory Recall
Interruptions
07
EMR systems cause redundancy in the physician workflow
EMR system lags and crashes, a lack of system personalization, and a need to input the same data multiple times leads to redundancy in the physician workflow, slowing physicians down. This uncertainty and repetition in the workflow causes anxiety and frustration.
Attention
Memory Recall
08
Physicians employ customizations to speed up their workflow
Over their careers, physicians maneuver usability issues in EMR systems, customizing these systems and creating workarounds; physicians leverage Google Docs of common phrases to reference and adapted screen orientations to decrease scrolling and speed up their workflow.
Maintaining Goals
09
The primary care role requires wearing multiple hats
Due to the preventative nature of their work, primary care physicians are concerned with the holistic health of their patients. When lacking immediate access to other specialties, primary care physicians often wear multiple hats and take on additional administrative responsibilities.
Attention
Task-Switching
10
Burnout is due to career stage
Burnout differed among physicians based on career stage rather than generation. Early-career physicians take on more patients due to low tenure, take over patients from retiring physicians who trust them less, lack knowledge from experience, and have their authority questioned.
Attention
Emotion Regulation
We are a team of five master's students in Carnegie Mellon's Human-Computer Interaction Institute (HCII). Gathehr was created as part of our Capstone (MHCI 2022) Project, working with Optum/ UnitedHealth Group.
