As capabilities for storing and sharing electronic health data expand, it becomes increasingly important to classify, prioritize, and contextually link patient health data. Providers using electronic health records complain that it is difficult for them to rapidly find the information they need and that key information can be missed. Different data is important depending on details associated with the patient, the clinician who is accessing the data, and the context in which data are accessed. In this project we will employ knowledge elicitation methods to study information access patterns and priorities of clinicians. Our approach involves the novel use of recorded eye-tracking data from true clinical environments to support retrospective verbal protocol analysis of information access. Specifically, researchers will interview providers and ask them to describe what they were doing and thinking while watching video-playback of what the provider looked at, did, and said during actual information seeking in the context of patient care. We will use qualitative data analysis methods (constant comparative analysis with open and axial coding) to identify emerging themes related to information seeking in the context of intensive care at two institutions with very different processes for storing and presenting electronic health data. Our primary goal is to use the results of this effort to generate principles to improve the organization and prioritization of data in electronic health records. A secondary goal is to identify specific criteria for ranking the importance of electronic health data for future development of advanced computational methods that will support alternative display techniques to make it easy for caregivers to find and interpret relevant and important information quickly. Previous research has focused on either (1) qualitative research in the form of interviews or focus groups that emphasizes information that the provider can easily recall and lacks a realistic representation of how providers use data in the field, or (2) field observations or techniques such as key press data capture that lack explanatory power. Integrating field observation data and rich commentary through retrospective verbal protocol in the context of an eye-tracking video record of actual data use is an innovative technique to capitalize on strengths of both approaches. Researchers, designers, and developers of electronic health records can use the results of this effort toward better-organized and perhaps intelligent display of patient data to support clinical decisions. This research project is significant in its potential to increase efficiency in patient care through faster access and analysis of data and to improve safety by reducing the chances that critical information is overlooked or misinterpreted.

Public Health Relevance

Efficient access to important patient data is critical to both patient safety and cost effectiveness of the current and future health care system. This project proposes a unique approach to eliciting provider descriptions of the relative importance of specific health data in the context of their own data use activities. These descriptions will be analyzed to identify emerging themes related to information seeking and principles that can be applied to the organization and prioritization of clinical health data. This proposal has significant implications for the design of electronic health records to support faster information access and to ensure that critical information is not missed.

National Institute of Health (NIH)
National Library of Medicine (NLM)
Exploratory/Developmental Grants (R21)
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Biomedical Library and Informatics Review Committee (BLR)
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Vanbiervliet, Alan
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Duke University
Schools of Medicine
United States
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Wright, Melanie C; Dunbar, Sherry; Macpherson, Brekk C et al. (2016) Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort. Appl Clin Inform 7:912-929