A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment

Geriatric Research, Education, and Clinical Center (182), George E. Wahlen Department of Veterans Affairs Medical Center, 500 Foothill Dr., Salt Lake City, UT 84148, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 01/2007; 14(1):65-75. DOI: 10.1197/jamia.M2231
Source: DBLP


Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques.
Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers.
Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified.
Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented.
Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.

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Available from: Rebecca Campo, Oct 07, 2015
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    • "In situations, where it was not possible to organize focus groups, separate interviews were carried out. Nonparticipant observation sessions were embedded into the interview process and involved demonstrations and visualizations of issues discussed (Weir et al., 2007), for example, the type of data communicated, how messages were recorded, and the use of communication artifacts. Research notes of interviews, focus groups, and observations were recorded in a research log, along with memos reflecting on the data. "
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    • "This method is useful for examining new or existing systems. Understanding the process and task structure of a backing task may shed more light on how such collisions can occur [27]. TA can provide additional insights on drivers' abilities during the driving task by identifying the physical, as well as a few cognitive processes, i.e., determining when it is safe to proceed. "
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    • "This can include consideration about the time a task is due, the length of time it takes to complete a task or even the period that is required for each task. If this information is not known, e.g., when the patient was last seen, the number of times a test has been repeated, it usually means that people have to revert to verbal communication or other workaround to confirm information [70]. "
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