http://clinfowiki.org/wiki/index.php?title=Click_frustration&feed=atom&action=historyClick frustration - Revision history2024-03-29T10:13:40ZRevision history for this page on the wikiMediaWiki 1.22.4http://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=11891&oldid=prevAnnathehybrid at 14:29, 13 October 20112011-10-13T14:29:23Z<p></p>
<a href="http://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=11891&oldid=7384">Show changes</a>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7384&oldid=prevNdgoldstein at 19:39, 19 February 20092009-02-19T19:39:31Z<p></p>
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</table>Ndgoldsteinhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7383&oldid=prevArildf at 08:37, 19 February 20092009-02-19T08:37:02Z<p></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>While the process described above is the process currently used, it must be expressed that it is not an optimal process.  There are a number of steps that could be streamlined to avoid click frustration, however, the goal of this article is not manage processes, but to define the frustrations that providers suffer while using the mouse clicks to interact with the electronic medical record.  It should also be noted that paper based charts have a separate process for refills, one which allowed charts to be brought to the provider, a refill request on the top of the chart and only a signature or initials were needed to provide the refill.  There are distinct differences between the paper-based and electronic processes which account for some of the frustrations that provider encounter.  It must be recognized that click frustration is not entirely a technical problem, but a frustration that occurs when inefficient electronic processes replace relatively time insensitive paper-based system.  A relatively simple manual process becomes a time and labor intensive adventure with clicks.  It is recognized that there are many more examples of click frustration in the current electronic medical records that exist and that many more click frustration processes will be implemented in the future, neither which offer excuses for the use who suffers from click frustration.       </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>While the process described above is the process currently used, it must be expressed that it is not an optimal process.  There are a number of steps that could be streamlined to avoid click frustration, however, the goal of this article is not manage processes, but to define the frustrations that providers suffer while using the mouse clicks to interact with the electronic medical record.  It should also be noted that paper based charts have a separate process for refills, one which allowed charts to be brought to the provider, a refill request on the top of the chart and only a signature or initials were needed to provide the refill.  There are distinct differences between the paper-based and electronic processes which account for some of the frustrations that provider encounter.  It must be recognized that click frustration is not entirely a technical problem, but a frustration that occurs when inefficient electronic processes replace relatively time insensitive paper-based system.  A relatively simple manual process becomes a time and labor intensive adventure with clicks.  It is recognized that there are many more examples of click frustration in the current electronic medical records that exist and that many more click frustration processes will be implemented in the future, neither which offer excuses for the use who suffers from click frustration.       </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">----</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>== References ==  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>== References ==<del class="diffchange diffchange-inline">'''  </del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[1]  Vashtz G (sp), Meyer J, Parmet Y, Peleg R, Goldfarb D, Porath A, Gilutz H.  Defining and measuring physicians' responses to clinical reminders.  J Biomed Inform. 2008 Oct 26.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[1]  Vashtz G (sp), Meyer J, Parmet Y, Peleg R, Goldfarb D, Porath A, Gilutz H.  Defining and measuring physicians' responses to clinical reminders.  J Biomed Inform. 2008 Oct 26.</div></td></tr>
</table>Arildfhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7382&oldid=prevTrevorrohm: link modification2009-02-18T21:30:30Z<p>link modification</p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:30, 18 February 2009</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [http://en.wikipedia.org/wiki/Event_driven event driven programming] paradigm.  This paradigm requires users to take an active approach to [http://en.wikipedia.org/wiki/Information_management information management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [http://en.wikipedia.org/wiki/Mouse_click event ] which drives the system.  While this concept is well known to all who use any type of windows based [http://en.wikipedia.org/wiki/User_interface user interface ], the problem is multiplied by the complexity of the electronic medical record.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [http://en.wikipedia.org/wiki/Event_driven event driven programming] paradigm.  This paradigm requires users to take an active approach to [http://en.wikipedia.org/wiki/Information_management information management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [http://en.wikipedia.org/wiki/Mouse_click event ] which drives the system.  While this concept is well known to all who use any type of windows based [http://en.wikipedia.org/wiki/User_interface user interface], the problem is multiplied by the complexity of the electronic medical record.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [http://en.wikipedia.org/wiki/Psychiatric psychiatric] and [http://en.wikipedia.org/wiki/Psychological psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [<del class="diffchange diffchange-inline">[</del>ePrescribing<del class="diffchange diffchange-inline">]</del>].  In one such system, to refill a medication, the following step must be taken:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [http://en.wikipedia.org/wiki/Psychiatric psychiatric] and [http://en.wikipedia.org/wiki/Psychological psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [<ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Eprescribing </ins>ePrescribing].  In one such system, to refill a medication, the following step must be taken:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7381&oldid=prevTrevorrohm: link edit2009-02-18T21:27:39Z<p>link edit</p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:27, 18 February 2009</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [http://www.clinfowiki.org/wiki/index.php/Alert_Fatigue<del class="diffchange diffchange-inline">[</del>alert fatigue<del class="diffchange diffchange-inline">]</del>], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [http://www.clinfowiki.org/wiki/index.php/Alert_Fatigue alert fatigue], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [<del class="diffchange diffchange-inline">event driven programming </del>http://en.wikipedia.org/wiki/Event_driven] paradigm.  This paradigm requires users to take an active approach to [<del class="diffchange diffchange-inline">information management </del>http://en.wikipedia.org/wiki/Information_management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [<del class="diffchange diffchange-inline">event </del>http://en.wikipedia.org/wiki/Mouse_click] which drives the system.  While this concept is well known to all who use any type of windows based [<del class="diffchange diffchange-inline">user interface </del>http://en.wikipedia.org/wiki/User_interface], the problem is multiplied by the complexity of the electronic medical record.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [http://en.wikipedia.org/wiki/Event_driven <ins class="diffchange diffchange-inline">event driven programming</ins>] paradigm.  This paradigm requires users to take an active approach to [http://en.wikipedia.org/wiki/Information_management <ins class="diffchange diffchange-inline">information management</ins>].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [http://en.wikipedia.org/wiki/Mouse_click <ins class="diffchange diffchange-inline">event </ins>] which drives the system.  While this concept is well known to all who use any type of windows based [http://en.wikipedia.org/wiki/User_interface <ins class="diffchange diffchange-inline">user interface </ins>], the problem is multiplied by the complexity of the electronic medical record.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [<del class="diffchange diffchange-inline">psychiatric </del>http://en.wikipedia.org/wiki/Psychiatric] and [<del class="diffchange diffchange-inline">psychological </del>http://en.wikipedia.org/wiki/Psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[ePrescribing]].  In one such system, to refill a medication, the following step must be taken:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [http://en.wikipedia.org/wiki/Psychiatric <ins class="diffchange diffchange-inline">psychiatric</ins>] and [http://en.wikipedia.org/wiki/Psychological <ins class="diffchange diffchange-inline">psychological</ins>] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[ePrescribing]].  In one such system, to refill a medication, the following step must be taken:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7380&oldid=prevTrevorrohm: edit links2009-02-18T21:25:54Z<p>edit links</p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:25, 18 February 2009</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [<del class="diffchange diffchange-inline">[alert fatigue]</del>http://www.clinfowiki.org/wiki/index.php/Alert_Fatigue], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [http://www.clinfowiki.org/wiki/index.php/Alert_Fatigue<ins class="diffchange diffchange-inline">[alert fatigue]</ins>], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7379&oldid=prevTrevorrohm: links added2009-02-18T21:22:10Z<p>links added</p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:22, 18 February 2009</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [[alert fatigue]], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to [[alert fatigue]<ins class="diffchange diffchange-inline">http://www.clinfowiki.org/wiki/index.php/Alert_Fatigue</ins>], has blossomed with the development of the electronic medical record ([[EMR]]).  While alert fatigue tends to be related to clinical decision support ([[CDS]]), click frustration deals more with the entire electronic medical record.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [event driven programming] paradigm.  This paradigm requires users to take an active approach to [information management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [event] which drives the system.  While this concept is well known to all who use any type of windows based [user interface], the problem is multiplied by the complexity of the electronic medical record.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [event driven programming <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Event_driven</ins>] paradigm.  This paradigm requires users to take an active approach to [information management <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Information_management</ins>].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [event <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Mouse_click</ins>] which drives the system.  While this concept is well known to all who use any type of windows based [user interface <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/User_interface</ins>], the problem is multiplied by the complexity of the electronic medical record.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [psychiatric] and [psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[ePrescribing]].  In one such system, to refill a medication, the following step must be taken:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [psychiatric <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Psychiatric</ins>] and [psychological <ins class="diffchange diffchange-inline">http://en.wikipedia.org/wiki/Psychological</ins>] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[ePrescribing]].  In one such system, to refill a medication, the following step must be taken:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7378&oldid=prevTrevorrohm at 21:16, 18 February 20092009-02-18T21:16:54Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:16, 18 February 2009</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 7:</td>
<td colspan="2" class="diff-lineno">Line 7:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [event driven programming] paradigm.  This paradigm requires users to take an active approach to [information management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [event] which drives the system.  While this concept is well known to all who use any type of windows based [user interface], the problem is multiplied by the complexity of the electronic medical record.   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the [event driven programming] paradigm.  This paradigm requires users to take an active approach to [information management].  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an [event] which drives the system.  While this concept is well known to all who use any type of windows based [user interface], the problem is multiplied by the complexity of the electronic medical record.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [psychiatric] and [psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[<del class="diffchange diffchange-inline">e-Prescribing</del>]].  In one such system, to refill a medication, the following step must be taken:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the [psychiatric] and [psychological] manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for [[<ins class="diffchange diffchange-inline">ePrescribing</ins>]].  In one such system, to refill a medication, the following step must be taken:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7377&oldid=prevTrevorrohm: links added2009-02-18T21:16:12Z<p>links added</p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:16, 18 February 2009</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to alert fatigue, has blossomed with the development of the electronic medical record (EMR).  While alert fatigue tends to be related to clinical decision support (CDS), click frustration deals more with the entire electronic medical record.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to <ins class="diffchange diffchange-inline">[[</ins>alert fatigue<ins class="diffchange diffchange-inline">]]</ins>, has blossomed with the development of the electronic medical record (<ins class="diffchange diffchange-inline">[[</ins>EMR<ins class="diffchange diffchange-inline">]]</ins>).  While alert fatigue tends to be related to clinical decision support (<ins class="diffchange diffchange-inline">[[</ins>CDS<ins class="diffchange diffchange-inline">]]</ins>), click frustration deals more with the entire electronic medical record.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In order to understand click frustration, a basic understanding of alert fatigue is necessary.  Alert warnings, reminders, and recommendations have been well defined in CDS [1][2].  Alert fatigue is related to the barrage of message provided by a CDS which can overwhelm a provider and cause them to ignore messages.  Stelle et al showed that providers will adhere to some alerts, which can be used to improve patient care and ensure that proper corollary orders are also input [3].  Corollary orders have been shown an improvement of provider adherence to guidelines and a decrease in errors of omission [4].  While disabling drug-drug interactions alerts is one potential method of dealing with the problem of alert fatigue, there seems to be no consensus on which alerts are needed and how to safely disable the alerts [5].  Other studies show positive effects of alerts [6].  There are other studies that show alert threshold can affect provider attitudes [7].  Regardless, CDS with alerts and reminders can improve patient safety and the quality of care [8].</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the event driven programming paradigm.  This paradigm requires users to take an active approach to information management.  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an event which drives the system.  While this concept is well known to all who use any type of windows based user interface, the problem is multiplied by the complexity of the electronic medical record.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Alert fatigue deals with actions that are needed by the user, responses and messages are generated by the decision support system.  Users must act on those alerts and reminders by taking action, whether that action be to implement the support recommendations or to ignore them, a user must react to the system.  Click frustration also incorporates user input.  Alert fatigue is an active response to CDS and system function.  Click frustration is a passive medium from an event driven approach to the EMR.  Unlike the active support provided by the CDS, all electronic records are based on the <ins class="diffchange diffchange-inline">[</ins>event driven programming<ins class="diffchange diffchange-inline">] </ins>paradigm.  This paradigm requires users to take an active approach to <ins class="diffchange diffchange-inline">[</ins>information management<ins class="diffchange diffchange-inline">]</ins>.  The user must make decision for system interactions, namely, use the mouse and keyboard for input and decision making tasks.  While in this course of events, the mouse click becomes an <ins class="diffchange diffchange-inline">[</ins>event<ins class="diffchange diffchange-inline">] </ins>which drives the system.  While this concept is well known to all who use any type of windows based <ins class="diffchange diffchange-inline">[</ins>user interface<ins class="diffchange diffchange-inline">]</ins>, the problem is multiplied by the complexity of the electronic medical record.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the psychiatric and psychological manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for e-Prescribing.  In one such system, to refill a medication, the following step must be taken:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Click frustration is therefore the <ins class="diffchange diffchange-inline">[</ins>psychiatric<ins class="diffchange diffchange-inline">] </ins>and <ins class="diffchange diffchange-inline">[</ins>psychological<ins class="diffchange diffchange-inline">] </ins>manifestations of repetitive clicks to the mouse button with the hopes of accomplishing some task in an electronic medical record, for which the task should not require repetitive mouse button clicks.  For example, most prominent electronic medical record systems use a prescription writing program for <ins class="diffchange diffchange-inline">[[</ins>e-Prescribing<ins class="diffchange diffchange-inline">]]</ins>.  In one such system, to refill a medication, the following step must be taken:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>1. Login to the EMR  </div></td></tr>
</table>Trevorrohmhttp://clinfowiki.org/wiki/index.php?title=Click_frustration&diff=7376&oldid=prevTrevorrohm at 21:12, 18 February 20092009-02-18T21:12:16Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 21:12, 18 February 2009</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== '''Click Frustration''' ==</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">----</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to alert fatigue, has blossomed with the development of the electronic medical record (EMR).  While alert fatigue tends to be related to clinical decision support (CDS), click frustration deals more with the entire electronic medical record.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Click frustration, a little known phenomenon closely related to alert fatigue, has blossomed with the development of the electronic medical record (EMR).  While alert fatigue tends to be related to clinical decision support (CDS), click frustration deals more with the entire electronic medical record.</div></td></tr>
<tr><td colspan="2" class="diff-lineno">Line 46:</td>
<td colspan="2" class="diff-lineno">Line 43:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>6. Now the prescription is printed and must be manually signed.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>6. Now the prescription is printed and must be manually signed.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This example, for refilling one medication, took a minimum of 16-18 click of the mouse.  That does not account for time it took to load the application, no allergy alerts, no drug-drug interaction alerts, no changes to the original prescription.  What was once a simple signature by the provider on the paper-chart, has now become a process, with a minimum of 16 clicks by the provider.  This is by definition – click frustration.   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This example, for refilling one medication, took a minimum of 16-18 click of the mouse.  That does not account for time it took to load the application, no allergy alerts, no drug-drug interaction alerts, no changes to the original prescription.  What was once a simple signature by the provider on the paper-chart, has now become a process, with a minimum of 16 clicks by the provider.  This is by definition – click frustration.   </div></td></tr>
</table>Trevorrohm