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Electronic Health Records’ Support for Primary Care Physicians’ Situation Awareness: A Metanarrative Review
Human Factors: The Journal of the Human Factors and Ergonomics Society ( IF 3.3 ) Pub Date : 2021-05-25 , DOI: 10.1177/00187208211014300
April Savoy 1, 2, 3 , Himalaya Patel 2 , Daniel R Murphy 4, 5 , Ashley N D Meyer 4, 5 , Jennifer Herout 6 , Hardeep Singh 4, 5
Affiliation  

Objective

Situation awareness (SA) refers to people’s perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients’ risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)’ SA during clinical decision-making.

Method

We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP–EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs’ clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs’ levels of SA (1–Perception, 2–Comprehension, and 3–Projection) and identified SA barriers.

Results

From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload.

Conclusion

Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs’ SA, satisfaction, and decision-making.



中文翻译:

电子健康记录对初级保健医生态势感知的支持:元叙事回顾

客观的

态势感知(SA)是指人们对其动态环境的感知和理解。在初级保健中,医生的 SA 减少会增加临床决策中的错误,相应地,也会增加患者出现不良后果的风险。我们的目标是了解电子健康记录 (EHR) 在多大程度上支持初级保健医生 (PCP) 在临床决策过程中的 SA。

方法

我们对选定的学术数据库(包括 CINAHL 和 MEDLINE)中的论文进行了元叙事审查。符合条件的研究包括 2012 年 1 月至 2020 年 8 月期间发表的关于 PCP-EHR 相互作用的原始同行评审研究。我们反复查询、筛选和总结了侧重于支持 PCP 的成人临床决策和护理管理的 EHR 的文献。然后,我们将调查结果映射到已建立的 SA 框架,以对影响 PCP 的 SA 水平(1-感知、2-理解和 3-投射)的外部因素(个人、任务和系统)进行分类,并确定 SA 障碍。

结果

从确定的 1504 篇文章中,我们纳入并综合了 19 项研究。研究设计主要是非干预性的。研究描述了 EHR 工作流程错位、可用性问题和沟通挑战。EHR 信息,包括实验室结果和护理计划,被描述为不完整、不及时或不相关。未满足的信息需求使得 PCP 甚至难以获得基本的 SA,即 1 级 SA。PCP 使用 EHR 开发 SA 的普遍障碍是错误的心理模型、注意力隧道和数据过载。

结论

根据我们的审查,EHR 不支持在 PCP 中发展更高水平的 SA。审查结果表明,面向健康信息技术的 SA 设计流程可以改善 PCP 的 SA、满意度和决策制定。

更新日期:2021-05-26
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