Cognitive Analysis of a Highly Configurable Web 2.0 EHR Interface
This is a review of Senathirajah, Kaufman, and Bakken’s 2010 article, “Cognitive Analysis of a Highly Configurable Web 2.0 EHR Interface”. 
The researchers performed a study on MedWISE, an experimental customizable clinical system interface which allows users to shape and form information and interfaces in the EHR and also share their creations with their coworkers. The aim of this project is to provide a flexible user control than offered by existing EHR systems. Researchers reported the 13 clinicians’ for a laboratory dashboard function.
Authors summarized new core functionalities available in MedWISE that were related to their point of interests. These features considerably increase the role of users in the system, as listed below:
- Ability to gather and arrange EHR information on a single page via click mechanism
- Capable of making a custom lab panel for each lab user and share its information
- Ability to define a tab including user-collected fields and data as a template which can be shared with other users
- Capable of creating multi-dimensional plots for different lab test values along with different filtering capabilities
- Provide collapsible/expandable components which can be edited with modifiable header colors and titles
Researcher anticipated that the final output have a potential to increase flexibility and efficiency. They aimed to collect information with the following objectives:
- The completeness of user learn curve in a short (30 minute) training session.
- New functionalities that users use, their purposes, and combinations.
- User ratings on system ease of use and usefulness.
- The cognition-related user perceptions from the system.
Thirteen clinicians were recruited and given a survey about clinical experience, demographics, computer proficiency and use of social networking tools. Researchers tested users in a two-part protocol. In part 1, a video demonstrated about system features and a short printed manual handed to them. Afterwards, they were given a list of tasks to perform to carry out. Their on-screen actions and any expressions were recorded. The think aloud protocols and screen recordings contributed to a better understanding of the utility of the new features.  In part 2, users were given five patient cases, asked to use the system to familiarize themselves. At the end, they rated their perceptions of system ease of use and usefulness on a survey.
All users were able to learn and use core functions after the short training. Four different overall user interaction strategies and the use of specific new features were noted. All of participants used the system's new features. The most common feature used was plotting creatinine to determine the patient’s kidney function status and then setting this as a widget for future use. Spatial arrangement was used for categorization, workflow, and epistemic action. Participants mostly used the interface as a dynamic stage to collect relevant information. Several users commented on the possible time savings, reduction in cognitive load, and possible error reduction. User feedback and the short time required to learn the system indicated high ease of use. Nearly all users anticipated the system's usefulness for some functions. One user liked the single-page structure which forced him to think about important information in the system.
This study suggest that clinicians can easily learn to use customizable systems and also liked the kind of functionality. With appropriate set of tools, they can adapt the interface to fit their personal preferences. Researchers identified the single patient case, the small number of users and the fact that the study was a laboratory case as study limitations and believed that although these limitations can limit the research generalizability; the practice of real patient cases in a real environment is the strengths of the research.
The core features of this system show potential for improving efficiency, clinical reasoning and user satisfaction. It points out an important feature that can be added to the existing EHR system. One factor that needs attention for customizable EHR systems is the effects of customization on patient safety and any potential risk that this level of customization might generate.
- Senathirajah, Kaufman, and Bakken. Cognitive Analysis of a Highly Configurable Web 2.0 EHR Interface. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041363/