The impact of technology on physician cognition and performance

Anesthesiologists and intensive care specialists are struggling with the question of how to evaluate the impact of new information technology, especially when devices promise to benefit patient safety [1]. The value of many innovations in technology for anesthesia and critical care medicine, like automated record keeping, pulse oximetry, or integrated patient monitors, lies in their impact on the cognition of medical personnel processes such as attention, workload, and reasoning. In evaluating the impact o f new technology, the unit of analysis cannot be the new box or capability in isolation; rather, it must be the larger information processing system that includes the physician's cognitive processes, the set o f interacting physicians and medical personnel for that setting, and the set o f tools that influence the information processing of these people [2]. It is the person-machine system that needs to be evaluated, not simply an electronic box. The work by Loeb investigating the impact o f record-keeping technology on anesthesiologist workload and attention is one example of the direction in which technology assessment needs to move. He has taken one approach for investigating human performance, the dual task class of methods, and tried to adapt it to investigate anesthesiologis; performance during actual cases. In this class of methods, the investigators introduce an additional, or secondary, task that can be related or unrelated to the pr imary task. Variations in performance on the secondary task provide one indication of the workload or mental resources devoted to the pr imary task.