Investigation of Information Overload in Electronic Health Records: Protocol for Usability Study
Open accessAbstract
BACKGROUND: Electronic health records (EHRs) have been associated with information overload, causing providers to miss critical information, make errors, and delay care. Information overload can be especially prevalent in medical intensive care units (ICUs) where patients are often critically ill and their charts contain large amounts of data points such as vitals, test and laboratory results, medications, and notes. OBJECTIVE: We propose to study the relationship between information overload and EHR use among medical ICU providers in 4 major United States medical centers. In this study, we examined 2 prominent EHR systems in the United States to generate reproducible and generalizable findings. METHODS: Our study collected physiological and objective data through the use of a screen-mounted eye-tracker. We aim to characterize information overload in the EHR by examining ICU providers' decision-making and EHR usability. We also surveyed providers on their institution's EHR to better understand how they rate the system's task load and usability using the NASA (National Aeronautics and Space Administration) Task Load Index and Computer System Usability Questionnaire. Primary outcomes include the number of eye fixations during each case, the number of correct decisions, the time to complete each case, and number of screens visited. Secondary outcomes include case complexity performance, frequency of mouse clicks, and EHR task load and usability using provided surveys. RESULTS: This EHR usability study was funded in 2021. The study was initiated in 2022 with a completion date of 2025. Data collection for this study was completed in December 2023 and data analysis is ongoing with a total of 81 provider sessions recorded. CONCLUSIONS: Our study aims to characterize information overload in the EHR among medical ICU providers. By conducting a multisite, cross-sectional usability assessment of information overload in 2 leading EHRs, we hope to reveal mechanisms that explain information overload. The insights gained from this study may lead to potential improvements in EHR usability and interface design, which could improve health care delivery and patient safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/66127.
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Even as EHR data quality and completeness improve, the processes required to access and use that data may increase cognitive load and exacerbate information overload.
“Taken together, these findings suggest that even as EHR data quality and completeness improve, the processes required to access and use that data may increase cognitive load and exacerbate information overload23.”
From When better data meets better design: How EHR data usability and system usability shape physicians' cognitive load (2026) · cites this paper as [23]
The Introduction says EHRs can cause information overload and identifies poor data presentation and information-seeking and processing demands as relevant challenges; it also reports that information overload increases cognitive load. It does not discuss improving EHR data quality or completeness, so it does not support the claim’s 'even as' qualification. No page numbers are provided in our copy. (LLM, conf=0.84)
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Cites
Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research
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IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use
Lewis, J. R. (1995) · International Journal of Human-Computer Interaction · doi:10.1080/10447319509526110 · Cited by 2,429 · see citing works
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Sorted by citations
Merriweather, Lyytinen, K., Aron, D., & Cauley, M. R. (2026) · npj Digital Medicine · doi:10.1038/s41746-025-02243-4 · Cited by 9 · see citing works
- Authors
- Khairat, S., Morelli, J., Boynton, M. H., Bice, T., Gold, J. A., & Carson, S. S.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Oregon Health & Science University (US)
- Corresponding author
- Khairat, Saif
- Venue
- JMIR Research Protocols
- Publisher
- JMIR Publications Inc.
- Published
- 2025-02-11
- Volume
- 14
- Pages
- e66127
- ISSN
- 1929-0748 (ISSN-L)
- PMC
- PMC11862759
- OpenAlex
- W4407352895
- Cited by
- 9
- References
- 2
- Citations by year
- 2026: 6 · 2025: 3
- FWCI
- 7.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Research Protocols (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. National Library of Medicine (R01LM013606)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Decision Sciences › Information Systems and Management › Personal Information Management and User Behavior
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- information overload, electronic health records, EHR usability, medical intensive care unit, eye tracking, clinical decision-making, workload, NASA-TLX, Computer System Usability Questionnaire, patient safety, intensive care
- MeSH terms
- Humans, Intensive Care Units, Surveys and Questionnaires, United States, Workload, Electronic Health Records
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