Identifying EHR Novice Users’ Cognitive Challenges: Mapping Critical Nursing Tasks Using HTA

Rapid and widespread implementation of electronic health record (EHR) systems has been attributed to rising medical incidents in healthcare systems. Although previous research has evaluated and improved the usability of the EHR systems, there is limited understanding of EHR users’ cognitive challenges along the lifecycle of EHR data. Especially, nursing students, a novice user group, are considered amenable to reveal the user issues because of underdeveloped workarounds and automaticity. Therefore, this research aims to identify nursing students’ cognitive challenges and efforts regarding the use of the EHR system. As a first step of a multi-study research, the current study investigated cognitive work associated with five common critical nursing tasks that involve EHR usage. A Hierarchical Task Analysis (HTA) was conducted to build a hierarchical structure that represents critical functions and individual steps of each task, which will be used to explore potential areas that pose cognitive challenges to novice EHR users (i.e., nursing students). Preliminary findings are illustrated through HTA construction, which provides preliminary clues for possible cognitive errors. Additional studies are planned to triangulate HTA findings. Results from combined studies will provide a comprehensive examination of problem areas that require greater cognitive effort from novice users.