Effects of Time Constraints on Clinician–Computer Interaction: A Study on Information Synthesis from EHR Clinical Notes
Open accessAbstract
Background Time is a measurable and critical resource that affects the quality of services provided in clinical practice. There is limited insight into the effects of time restrictions on clinicians' cognitive processes with the electronic health record (EHR) in providing ambulatory care. Objective To understand the impact of time constraints on clinicians' synthesis of text-based EHR clinical notes. Methods We used an established clinician cognitive framework based on a think-aloud protocol. We studied interns' thought processes as they accomplished a set of four preformed ambulatory care clinical scenarios with and without time restrictions in a controlled setting. Results Interns most often synthesized details relevant to patients' problems and treatment, regardless of whether or not the time available for task performance was restricted. In contrast to previous findings, subsequent information commonly synthesized by clinicians related most commonly to the chronology of clinical events for the unrestricted time observations and to investigative procedures for the time-restricted sessions. There was no significant difference in the mean number of omission errors and incorrect deductions when interns synthesized the EHR clinical notes with and without time restrictions (3.5±0.5 vs. 2.3±0.5, p=0.14). Conclusion Our results suggest that the incidence of errors during clinicians' synthesis of EHR clinical notes is not increased with modest time restrictions, possibly due to effective adjustments of information processing strategies learned from the usual time-constrained nature of patient visits. Further research is required to investigate the effects of similar or more extreme time variations on cognitive processes employed with different levels of expertise, specialty, and with different care settings.
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Limited interaction impedes comprehensive information collection and patient observation, potentially increasing miscommunication.
“Limited interaction impedes comprehensive information collection and patient observation, potentially increasing miscommunication [116].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [116]
The Conclusion reports that time restrictions led clinicians to retrieve less available patient information from EHR notes. Section 1.2.1 also describes incomplete physician–patient communication during time-restricted visits. The paper does not show that limited interaction impedes patient observation or that it increases miscommunication; its own study concerned EHR-note synthesis, not patient interaction. (LLM, conf=0.86)
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- Authors
- Farri, O., Monsen, K. A., Pakhomov, S. V., Pieczkiewicz, D. S., Speedie, S. M., & Melton, G. B.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Melton, Genevieve B.
- ORCID
- Venue
- Journal of Biomedical Informatics
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 46
- Issue
- 6
- Pages
- 1136-1144
- ISSN
- 1532-0464 (ISSN-L)
- OpenAlex
- W2167892823
- Cited by
- 19
- References
- 56
- Citations by year
- 2026: 3 · 2025: 2 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2016: 2 · 2015: 3 · 2014: 2 · 2012: 1
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Biomedical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Minnesota
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Keywords
- time constraints, electronic health records, information synthesis, cognitive processes, outpatient care, medical interns, think-aloud, omission errors, information processing strategies
- MeSH terms
- Practice Patterns, Physicians', User-Computer Interface, Electronic Health Records
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