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Easing Cognitive Workload for Clinicians

Mobile technologies can reduce mental stress for clinicians while improving point-of-care data capture.

By Cheryl D. Parker, PhD, RN-BC, FHIMSS, CNIO, PatientSafe Solutions
Published on May 11, 2015

Originally published on Advance Healthcare Network.

Nurses accomplish more than 100 patient care and related activities per eight-hour shift,1 which creates a significant cognitive workload. Cognitive workload is defined as the physiological and mental demands that occur while performing a task or a combination of tasks and “emerges from the interaction between the requirements of a task, the circumstances under which it is performed, and the skills, behaviors, and perceptions of the operator.”2

For decades, nurses have used memory and handwritten notes to support their significant cognitive workload. Memory and handwritten notes, however, contribute to patient safety risks, such as missed care activities and important data being lost or inaccurately recorded in the electronic heath record (EHR). Many clinicians are choosing to use their personal smartphones to support their cognitive workload and share data between the care team, but that poses safety as well as HIPAA violation risks.

Clinicians need a single pocket-sized tool that can deliver contextual clinical information about their patients at the point of care, including reminders and updates, as well as communication tools to collaborate with the entire team. To this point, EHRs have not addressed these challenges because most are only accessible when clinicians are logged-in and facing the screen on a wall-mounted terminal, desktop or workstation-on-wheels.

Technology has finally reached the level where smart, mobile point-of-care technology that consolidates communication, workflow and charting needs can be provided with one device, allowing clinicians to spend more time with their patients. Not only does mobile technology help support clinicians’ cognitive workload which contributes to safer care, but it can also capture richer data at bedside and improve efficiency.

Outdated Communication Tools

Contributing to heavy cognitive workload are outdated communication technologies in use at most healthcare facilities. Clinicians must use communication tools straight from the 1990s or older: VoIP phones, pagers and overhead intercoms. However, recent survey results show 67% of registered nurses are instead using their personal smartphone for patient care activities,2 which poses a HIPAA violation risk to the hospital. Although a clinician sending a colleague a text message containing protected health information may be HIPAA compliant in some circumstances, if that message is delivered over an unsecure network, such as those offered by most wireless carriers, is a violation.3

Interruptions are numerous and contribute to clinicians’ cognitive workload. A recent study of two hospitals over 136 hours showed clinicians were interrupted 1,354 times, an average of once every six minutes. The study recorded a total of 200 errors, about 1.5 errors per hour.4

In an average shift, clinicians are working on accomplishing 11 to 21 tasks at any given moment.5 Multiple communication tools that cannot be efficiently silenced, provide only voice communications or are not consolidated to one device lead to more interruptions, greater risk of distraction and potentially more errors. It is no surprise so many clinicians are using their personal smartphone to help manage their cognitive workload and communicate with the care team.

While forbidding personal smartphone usage for work avoids protected health information (PHI) breach risks, completely avoiding a smartphone-based communication strategy for employed clinicians is not the best answer when designing a clinical communication strategy.

Improved Data Capture and Clinical Outcomes

Instead of forbidding smartphone technology clinicians clearly prefer to use, hospitals can leverage this technology and offer an enterprise mobile EHR overlay allowing them to work at the point of care with fewer interruptions, enabling more efficient and safe workflow. A smart, mobile EHR overlay at the point-of-care can also encourage richer data capture, including the “where, when, how, whom” of clinical interactions. Smartphone based mobile technology can be much more nimble in capturing data at the point-of-care-beyond the structured documentations needed for the EHR, these include location data, time-stamped interactions and communication patterns.

Data collection is essential for tracking and improving the efficiency of care, but also for improving patient outcomes, both of which are directly compensated under value-based payment contracts. In addition, the reduced interruptions and eased cognitive workload can ensure clinicians effectively accomplish all required care activities during rounds. Fewer missed activities reduce the risk of hospital-acquired conditions, such as pressure sores or pneumonia, both of which are financially penalized under Medicare.

Freeing clinicians from the computer screen to receive EMR reminders and notifications is a significant step in improving patient care and reducing cognitive workload. For example, if a nurse knows a new order is going to be placed by the physician, without mobile technology, she has to remember to return frequently to a computer to see if the order has come through. With smartphone-based solutions in place, she can continue about her patient care activities knowing that when the order is placed she will be notified no matter where she is.

Mobile Tools Enable Connected Care

A smart mobile EHR overlay system-owned by the hospital, returns the focus to the bedside instead of a computer terminal on a desk or mounted to the wall. With access to contextual clinical data and communication tools at the point of care, clinicians can deliver safe, quality and effective care with fewer interruptions, and collaborate more efficiently with the care team who may be spread around the hospital or in the community. Mobile technology at the bedside also encourages more accurate and comprehensive data capture where care actually happens, which can translate to better clinical quality data reporting for increased revenue under value-based payment models.

Cheryl D. Parker is the chief nursing informatics officer at PatientSafe Solutions.



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