Abstract
Objective The aim of this study is to study the impact of graphical representation of health
record data on physician decision-making to inform the design of health information
technology.
Materials and Methods We conducted a within participants crossover design study using a simulated electronic
health record (EHR) in which we presented cases with and without visualized data designed
to highlight important clinical trends or relationships, followed by assessment of
the impact on decision-making about next steps for patients with chronic diseases.
We then asked whether trends were observed and about usability and satisfaction using
validated usability questions and asked open-ended questions as well. Time to answer
questions was also collected.
Results Twenty-one primary care providers participated in the study, including five for testing
only and sixteen for the full study. Questions about clinical assessment or next actions
were answered correctly 55% of the time. Regarding objective trends in the data, participants
described noticing the trends 85% of the time. Differences in noticing trends or difficulty
level of questions were not statistically significant. Satisfaction with the tool
was high and participants agreed strongly that it helped them make better decisions
without adding to the time it took.
Discussion The simulation allowed us to test the impact of a visualization on clinician practice
in a realistic setting. Designers of EHRs should consider the ways information presentation
can affect decision-making.
Conclusion Testing visualization tools can be done in a clinically realistic context. Providers
desire visualizations and believe that they help them make better and faster decisions.
Keywords
visualization - decision-making - diabetes - congestive heart failure - electronic
health record
