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InLight EHR: “Cognitive Overload in the Exam Room .”

Cognitive Overload in the Exam Room

By PriMed-InLight EHR | Free Demo, Click Here …

Pri-Med InLight RGB-REVSEPTEMBER 4, 2015 – Physicians must process an overwhelming amount of clinical data during the course of a day spent examining patients. A physician seeing a patient with three active problems juggles an average of twenty individual pieces of data—such as medications, lab orders, and observations—as they assess and create a treatment plan.

The range of inputs is vast, from the patient’s highly subjective and personal story to the array of test results, consultant notes, medications, and endless interactions. All of this information is processed in the medical decision making (MDM) phase of the encounter.

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Likewise, there are countless outputs from a clinical encounter, ranging from new tests, to mediation reconciliation and prescribing, to consultations and referrals. Finally, there are post-visit implications, such as tests that require communication back to the patient.

If the physician sees an average of 15 patients per day, they are handling more than 300 critically important pieces of information. These collective inputs, outputs, and actions stretch the limits of multitasking capacity and put the physician too close to cognitive overload. Cognitive overload impairs medical decision making and can lead to medical errors and misdiagnosis.

Source-Oriented EHRs Make the Problem Worse

The design of today’s EHRs only exacerbates the problem by presenting patient data without thinking about the information discovery needs of clinical care. Patient health data is organized by its source. All lab results for a particular patient are listed together, regardless of the problem for which they were ordered. The same source-based organizing principle is used for medications, exam notes, orders, etc.

The most important narratives summarizing medical decision making are presented as a series of disconnected files that must be searched individually. When confronted with patients having multiple complex problems, physicians too often feel like they are “drowning in an ocean” of disorganized patient data.

Problem-Based EHR Thinks like a Doctor, Reducing Cognitive Overload

An EHR with the patient problem list as its organizing principle can help solve for cognitive overload. All notes, medications, labs, orders, referrals, etc. are associated with patient problems, as opposed to the source-oriented approach having separate lists of all notes, medications, labs, etc. for each patient.

Patient problems could then exist in various levels of differentiation (e.g., abdominal pain can turn out later to be an ulcer or GERD); problems can resolve (e.g., acute viral pharyngitis); or problems can become enduring.

In all cases, the problem list is then the index to the clinical conditions that characterize each individual patient. Test ordering is linked to the problems addressed at each clinical encounter. There may be overlap as some labs/tests/medications will apply to more than one condition, but these cases are accounted for and linkages are logical.

Pri-Med’s InLight EHR is the first problem-oriented medical record which allows you treat problems rather than symptoms. Click here to watch a short demo or sign up for a FREE trial!

1 reply »

  1. Great message. You’re way under, however, on your estimate of total information perused by the five senses of the Family Physician in each clinical encounter. We studied thoughts of five levels of FM residents and faculty at Ohio State University with meta-cognitive probe questions during video reviews and found that third year residents covered 300 or more bits of information of one type or another during the problem oriented visit with a patient with an undifferentiated problem. Faculty perused more than that. The cognitive scientist from Denison University, Frank Hassebrock, PhD, working with us on his sabbatical designed the project (part of his work) and co-presented at the Society of Teachers of Family medicine meeting in St Louis in the early 1990’s with us (Larry Bauer, MSW, MEd). Many physicians chunk information together so well that they don’t realize how rich their thoughts are. Any FM physician who thinks they only deal with 20 pieces per visit is out of touch with their cognitive processes. FYI.

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