Thomas Reese1, Noa Segall2, Paige Nesbitt3, Guilherme Del Fiol1, Rosalie Waller1, Brekk C Macpherson4, Joseph E Tonna5, Melanie C Wright3. 1. Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA. 2. Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. 3. Trinity Health and Saint Alphonsus Regional Medical Center, Boise, ID, USA. 4. School of Nursing, Virginia Commonwealth University, Richmond, VA, USA. 5. Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Abstract
Introduction: Many electronic health records fail to support information uptake because they impose low-level information organization tasks on users. Clinical concept-oriented views have shown information processing improvements, but the specifics of this organization for critical care are unclear. Objective: To determine high-level cognitive processes and patient information organization schema in critical care. Methods: We conducted an open card sort of 29 patient data elements and a modified Delphi card sort of 65 patient data elements. Study participants were 39 clinicians with varied critical care training and experience. We analyzed the open sort with a hierarchical cluster analysis (HCA) and factor analysis (FA). The Delphi sort was split into three initiating groups that resulted in three unique solutions. We compared results between open sort analyses (HCA and FA), between card sorting exercises (open and Delphi), and across the Delphi solutions. Results: Between the HCA and FA, we observed common constructs including cardiovascular and hemodynamics, infectious disease, medications, neurology, patient overview, respiratory, and vital signs. The more comprehensive Delphi sort solutions also included gastrointestinal, renal, and imaging constructs. Conclusions: We identified primarily system-based groupings (e.g., cardiovascular, respiratory). Source-based (e.g., medications, laboratory) groups became apparent when participants were asked to sort a longer list of concepts. These results suggest a hybrid approach to information organization, which may combine systems, source, or problem-based groupings, best supports clinicians' mental models. These results can contribute to the design of information displays to better support clinicians' access and interpretation of information for critical care decisions.
Introduction: Many electronic health records fail to support information uptake because they impose low-level information organization tasks on users. Clinical concept-oriented views have shown information processing improvements, but the specifics of this organization for critical care are unclear. Objective: To determine high-level cognitive processes and patient information organization schema in critical care. Methods: We conducted an open card sort of 29 patient data elements and a modified Delphi card sort of 65 patient data elements. Study participants were 39 clinicians with varied critical care training and experience. We analyzed the open sort with a hierarchical cluster analysis (HCA) and factor analysis (FA). The Delphi sort was split into three initiating groups that resulted in three unique solutions. We compared results between open sort analyses (HCA and FA), between card sorting exercises (open and Delphi), and across the Delphi solutions. Results: Between the HCA and FA, we observed common constructs including cardiovascular and hemodynamics, infectious disease, medications, neurology, patient overview, respiratory, and vital signs. The more comprehensive Delphi sort solutions also included gastrointestinal, renal, and imaging constructs. Conclusions: We identified primarily system-based groupings (e.g., cardiovascular, respiratory). Source-based (e.g., medications, laboratory) groups became apparent when participants were asked to sort a longer list of concepts. These results suggest a hybrid approach to information organization, which may combine systems, source, or problem-based groupings, best supports clinicians' mental models. These results can contribute to the design of information displays to better support clinicians' access and interpretation of information for critical care decisions.
Authors: Mikhail A Dziadzko; Vitaly Herasevich; Ayan Sen; Brian W Pickering; Ann-Marie A Knight; Pablo Moreno Franco Journal: Int J Med Inform Date: 2016-01-29 Impact factor: 4.046
Authors: Thomas J Reese; Guilherme Del Fiol; Joseph E Tonna; Kensaku Kawamoto; Noa Segall; Charlene Weir; Brekk C Macpherson; Polina Kukhareva; Melanie C Wright Journal: J Am Med Inform Assoc Date: 2020-08-01 Impact factor: 4.497
Authors: Melanie C Wright; Damian Borbolla; Rosalie G Waller; Guilherme Del Fiol; Thomas Reese; Paige Nesbitt; Noa Segall Journal: J Biomed Inform X Date: 2019-06-22
Authors: Kensaku Kawamoto; Polina V Kukhareva; Charlene Weir; Michael C Flynn; Claude J Nanjo; Douglas K Martin; Phillip B Warner; David E Shields; Salvador Rodriguez-Loya; Richard L Bradshaw; Ryan C Cornia; Thomas J Reese; Heidi S Kramer; Teresa Taft; Rebecca L Curran; Keaton L Morgan; Damian Borbolla; Maia Hightower; William J Turnbull; Michael B Strong; Wendy W Chapman; Travis Gregory; Carole H Stipelman; Julie H Shakib; Rachel Hess; Jonathan P Boltax; Joseph P Habboushe; Farrant Sakaguchi; Kyle M Turner; Scott P Narus; Shinji Tarumi; Wataru Takeuchi; Hideyuki Ban; David W Wetter; Cho Lam; Tanner J Caverly; Angela Fagerlin; Chuck Norlin; Daniel C Malone; Kimberly A Kaphingst; Wendy K Kohlmann; Benjamin S Brooke; Guilherme Del Fiol Journal: JAMIA Open Date: 2021-07-31