Sunday, April 18, 2010

Electronic health record use and physician multitasking performance

"LLamas" has a pithy, if unfortunately unreferenced, summary of how most brains fail when they're trying to multitask ...
Llamas and my stegosaurus: Living with a limited brain

Some interesting research has come out recently about the processing capacity of brains. For example, that the medial prefrontal cortex can only handle two tasks at once, or that working memory can only handle about 7 items at a time (but what's an item?), or that when people are actively trying to remember something complicated, their impulse control is reduced. In fact, there has been a lot of research showing that exerting the will to make a difficult decision uses a fuel resource (sugar from the blood) that many of these other tasks also need.

What happens when these resources are used up? When we have been thinking too hard, or have been under heavy stress, or haven't had enough to eat or sleep, or are trying to remember too many things, or are trying to drive, or need a fix,we fall back on a simpler part of the brain. We lose the ability to think rationally, to choose future benefit over immediate reward; the ability to choose at all is reduced. We become irritable, forgetful, angry, quick to argue....
I've been disappointed that there have been few studies of how physician cognition adjusts to using automation tools (electronic health records, etc) during patient care. These tools all seem to have a substantially higher cognitive burden than phone use, but the impact of phone conversations on driving performance has been studied to death. Do physicians become more irritation and distracted when they try to simultaneously talk with patients, think about the answers, and use current clinical software?


Rebecca Morehead said...

Gordon I agree with you and would love to see a study on how multitasking is affecting physicians especially related to electronic health records.

We know that patients do not appreciate the provider looking at a computer screen instead of eye to eye during the visit.

It takes skill to multitask and be good at it. How accurate records will be in an electronic arena with so much going on at the same time is yet to be seen.

Thanks for the article.

Anonymous said...

As a therapist working in mental health, I often argue with co-workers who list EMR information from drop-down lists, that I cannot and will not do EMR notes while with the patient. I need to observe the client's behavior and body language, not just hear their words as I face the keyboard/monitor and I cannot divide my concentration to be "present" to do both tasks at the same time.
I see way too many EMR entries that are insufficient or incomplete because the provider was busy doing "something else". I will continue to do what some people feel is more work than necessary, but I know I serve my patients well AND write good notes.
More research, please.
Chris Beckingham, LMSW