Relating Task Demand, Mental Effort and Task Difficulty with Physicians’ Performance during Interactions with Electronic Health Records (EHRs)

ABSTRACT Objective was to assess the relationship between task demand, mental effort, task difficulty, and performance during physicians’ interaction with electronic health records (EHRs). Seventeen physicians performed three EHR-based scenarios with varying task demands. Mental effort was measured using eye tracking measures via task evoked pupillary responses (TEPR), blink frequency, and gaze speed; task difficulty (or user behavior) was measured using frequent mouse click patterns and task flow; user performance was quantified using two types of omission errors: (i) omission errors with no evidence of trying to complete the task and (ii) omission error with evidence of trying but unable to complete the task. The results indicated that task demand significantly increased mental effort, but not task difficulty. Task demand, mental effort, and task difficulty all predicted performance. Specifically, there was a significant relationship between (i) task demand, TEPR and omission errors with no evidence of trying to complete the task, and (ii) blink frequency, repeated search clicks and omission error with evidence of trying but unable to complete the task. In concert, results suggest that physicians’ performance during EHR interaction was negatively affected by task demands and increase in mental effort. This highlight the need for implementation of appropriate quality assurance (QA) measures, in addition to EHR usability improvement, to minimize omission errors and improve physician’s performance. Additionally, the lack of relationship between task demand and task difficulty highlights a need for further methodological and empirical studies to advance our understanding from theory to application during physician–EHR interaction.