Cognitive Overload Is a Problem for Clinicians; Approaching Technology Differently May Be the Solution

May, 2019

HIMSS Report

This guest blog is by Brendan Fitzgerald, Sr. Director of Research Services at HIMSS Analytics, now part of Definitive Healthcare.

Cognitive overload affecting clinical care team members is an increasing concern for hospitals. Clinicians need to process and coordinate vast amounts of knowledge, information, and context stemming from an explosion of clinical data and an increasing focus on team-based patient care.ⁱ And research shows that cognitive overload has significant consequences on clinical quality and errors.^{ii iii}

In healthcare, technology is one of the major forces shaping changes in clinical practice, communication, and collaboration. But is all healthcare technology necessarily imposing a burden that lessens the quality of practice and patient care? We wanted to find out.

Before and during HIMSS19, Vocera worked with HIMSS Analytics to survey 323 hospital clinical and IT leaders. Vocera issued a report with research conducted by HIMSS Analytics titled Research Findings: Technology and Cognitive Overload – Easing the Pain.

Participants answered nine questions about the signs and symptoms of cognitive overload they’ve observed, how technology contributes to it, and whether and how technology improvements and investments can mitigate cognitive burden.

As we studied the data, several themes stood out about the differences in respondents’ perceptions:

• Clinical respondents were more aware than IT respondents of nearly every cognitive overload symptom.
• Leaders showed a stronger awareness of the ramifications of cognitive overload than frontline team members.
• IT leaders and clinical leaders have different ideas about how to solve the problem.

What Cognitive Overload Looks Like

In the study Vocera worked on with HIMSS Analytics last year at HIMSS18, participants answered questions about managing interruptions from technology-based sources such as phone calls, pages, texts, notifications, alerts, and alarms. All clinical leaders we surveyed said system-based interruptions disrupt focus on patient care to some degree.

Whereas last year’s study focused on how hospitals measure and manage technology-based interruptions, this year’s study dug deeper into understanding the signs of cognitive overload and technology changes that could help address it.

One question we asked respondents this year is what, if any, signs of cognitive overload they have observed in their clinical environments. Seventy-seven percent reported that clinicians appeared stressed or overwhelmed. Almost two-thirds said cognitive overload makes clinicians reluctant to adopt new technologies. More than half said clinical team members ignore or fail to notice actionable alerts – an issue with potential to affect care quality and safety.

Better Integration of Technology into Workflow Would Help

Forty-two percent of survey respondents said that technology contributes considerably or significantly to cognitive overload. Another 44% said it contributes at least moderately.

Respondents overwhelmingly identified documenting and charting in the EHR as a source of cognitive overload. More than half point to alarms, retrieving data from EHRs, and trying to communicate with fellow care team members via technology as sources of cognitive burden. The likely reason is that in many hospitals, tools used for communication such as pagers, standalone texting platforms, and some mobile apps are not integrated into a consolidated software workflow. And since cognitive overload stems from the cumulative effects of multiple stimuli, each problematic task contributes to the overall burden.

Which Technology Improvements Would Help Most

Sixty-two percent of respondents cited intelligent workflows to route alerts and alarms more efficiently as the technology improvement that would have the greatest impact on reducing clinician cognitive overload. IT leaders see more value in integrating communication systems with the EHR, while clinical leaders place higher value on interface usability and enabling communication with the right care team member at the right time.

When we zeroed in on communication technologies that would minimize the cognitive burden on clinicians, respondents identified mobile solutions as having the greatest potential to alleviate the pain. Seventy-one percent of respondents identified mobile apps that enable care coordination and communication across multiple care team members as a top solution, while 67% said proactively pushing relevant EHR data to the right nurse at the right time on his or her mobile device would help.

Minimizing Cognitive Burden Is Important to Organizational Success

Seventy-seven percent of respondents said tackling cognitive overload is very or extremely important to organizational success. Yet technology in and of itself is not the root cause of the problem; the root cause is technology implemented without the appropriate interfaces, integration, and workflow considerations.

How Healthcare Leaders Can Help Reduce Cognitive Burden

To help minimize cognitive burden, technology needs to simplify and streamline clinical communication and workflows. It must help clinicians identify the most important information easily and must provide relevant clinical context while simultaneously weeding out extraneous information. It needs to give care teams a single, common source of information and standardized protocols for communication so all team members can collaborate effectively. ^iv

Download the report, Research Findings: Technology and Cognitive Overload – Easing the Pain.

View the recorded webinar.

i https://www.aapa.org/news-central/2017/02/patients-complex-patients/
ii Westbrook JI, Raban MZ, Walter SR, et al Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study BMJ Qual Saf 2018;27:655-663. https://qualitysafety.bmj.com/content/27/8/655
iii https://www.ncbi.nlm.nih.gov/books/NBK20475/
iv https://www.beckershospitalreview.com/a-5-point-communication-strategy-to-help-reduce-clinicians-cognitive-load.html