Electronic Health Records' Support for Primary Care Physicians' Situation Awareness: A Metanarrative Review

Authors

April Savoy
Himalaya Patel
Daniel R Murphy
Ashley N D Meyer
Jennifer Herout
Hardeep Singh

Publication Date

3-1-2023

Journal

Human Factors

DOI

10.1177/00187208211014300

PMID

34033500

PMCID

PMC9969495

PubMedCentral® Posted Date

5-21-2021

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Adult, Humans, Physicians, Primary Care, Awareness, Electronic Health Records, Attitude of Health Personnel, Communication, situation awareness, primary care, electronic health record, cognition, decision-making, safety

Abstract

OBJECTIVE: Situation awareness (SA) refers to people's perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients' risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)' SA during clinical decision-making.

METHOD: We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP-EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs' clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs' levels of SA (1-Perception, 2-Comprehension, and 3-Projection) and identified SA barriers.

RESULTS: From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload.

CONCLUSION: Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs' SA, satisfaction, and decision-making.