Toward Better Understanding of Task Difficulty during Physicians’ Interaction with Electronic Health Record System (EHRs)

ABSTRACT The goal of this study was to assess the relationship of task difficulty and mental effort with performance during physicians’ interaction with electronic health records (EHRs). A total of 38 physicians were asked to identify abnormal results and take follow-up action to “close the loop” on care delivery. Task difficulty was quantified via task-flow strategies and computer mouse-click patterns. Mental effort was quantified using eye movements based on changes in pupillary dilations (task evoked pupillary response or TEPR) and blink rate. Performance was quantified based on commission errors (error vs. no-error). Results indicated that physicians had different task-flow strategies; however, with improved awareness of the patient status, they exhibited an optimal task-flow strategy. Overall, performance was related to task-flow strategies, computer mouse-click patterns, and blink rate, indicating that physicians had lower task-difficulty and experienced lower mental effort with improved awareness of patient follow-up status. This is an important finding demonstrating that task-flows are a dominant predictor of physician performance when comparing between EHR designs. On the contrary, mouse-click patterns and blink rate are both useful predictors of physician performance when assessment was done within an EHR.