{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T01:34:20Z","timestamp":1775957660926,"version":"3.50.1"},"reference-count":57,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institutes of Health, U.S. National Library of Medicine","award":["T15LM007059"],"award-info":[{"award-number":["T15LM007059"]}]},{"name":"National Institutes of Health, U.S. National Library of Medicine","award":["R01LM012095"],"award-info":[{"award-number":["R01LM012095"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Complex electronic medical records (EMRs) presenting large amounts of data create risks of cognitive overload. We are designing a Learning EMR (LEMR) system that utilizes models of intensive care unit (ICU) physicians' data access patterns to identify and then highlight the most relevant data for each patient.<\/jats:p><jats:p>Objectives\u2003We used insights from literature and feedback from potential users to inform the design of an EMR display capable of highlighting relevant information.<\/jats:p><jats:p>Methods\u2003We used a review of relevant literature to guide the design of preliminary paper prototypes of the LEMR user interface. We observed five ICU physicians using their current EMR systems in preparation for morning rounds. Participants were interviewed and asked to explain their interactions and challenges with the EMR systems. Findings informed the revision of our prototypes. Finally, we conducted a focus group with five ICU physicians to elicit feedback on our designs and to generate ideas for our final prototypes using participatory design methods.<\/jats:p><jats:p>Results\u2003Participating physicians expressed support for the LEMR system. Identified design requirements included the display of data essential for every patient together with diagnosis-specific data and new or significantly changed information. Respondents expressed preferences for fishbones to organize labs, mouseovers to access additional details, and unobtrusive alerts minimizing color-coding. To address the concern about possible physician overreliance on highlighting, participants suggested that non-highlighted data should remain accessible. Study findings led to revised prototypes, which will inform the development of a functional user interface.<\/jats:p><jats:p>Conclusion\u2003In the feedback we received, physicians supported pursuing the concept of a LEMR system. By introducing novel ways to support physicians' cognitive abilities, such a system has the potential to enhance physician EMR use and lead to better patient outcomes. Future plans include laboratory studies of both the utility of the proposed designs on decision-making, and the possible impact of any automation bias.<\/jats:p>","DOI":"10.1055\/s-0040-1709707","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T05:33:32Z","timestamp":1602740012000},"page":"680-691","source":"Crossref","is-referenced-by-count":12,"title":["Graphical Presentations of Clinical Data in a Learning Electronic Medical Record"],"prefix":"10.1055","volume":"11","author":[{"given":"Luca","family":"Calzoni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilles","family":"Clermont","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory F.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"},{"name":"Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam","family":"Visweswaran","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"},{"name":"Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Hochheiser","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"},{"name":"Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/j.1471-1842.2004.00506.x","article-title":"Information overload within the health care system: a literature review","volume":"21","author":"A Hall","year":"2004","journal-title":"Health Info Libr J"},{"key":"ref2","first-page":"1967","article-title":"Development and preliminary evaluation of a prototype of a Learning Electronic Medical Record system","volume":"2015","author":"A J King","year":"2015","journal-title":"AMIA Annu Symp Proc"},{"key":"ref3","first-page":"512","article-title":"Eye-tracking for clinical decision support: a method to capture automatically what physicians are viewing in the EMR","volume":"2017","author":"A J King","year":"2017","journal-title":"AMIA Jt Summits Transl Sci Proc"},{"key":"ref4","first-page":"673","article-title":"Using machine learning to predict the information seeking behavior of clinicians using an electronic medical record system","volume":"2018","author":"A J King","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1561\/1100000039","article-title":"Interactive information visualization to explore and query Electronic Health Records","volume":"5","author":"A Rind","year":"2013","journal-title":"Found Trends Human\u2013Computer Interact."},{"key":"ref6","volume-title":"Computational Technology for Effective Health Care. Vol 22","author":"W W Stead","year":"2009"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1136\/amiajnl-2014-002955","article-title":"Innovative information visualization of Electronic Health Record data: a systematic review","volume":"22","author":"V L West","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"ref8","first-page":"303","article-title":"Pre-post evaluation of physicians' satisfaction with a redesigned electronic medical record system","volume":"136","author":"M WM Jaspers","year":"2008","journal-title":"Stud Health Technol Inform"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1093\/jamia\/ocv013","article-title":"Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems","volume":"22","author":"D F Sittig","year":"2015","journal-title":"J Am Med Inform Assoc"},{"key":"ref10","volume-title":"Electronic Health Record Usability: Interface Design Considerations. Vol 09","author":"D Armijo","year":"2009"},{"issue":"08","key":"ref11","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1108\/EUM0000000006984","article-title":"Perspectives on information overload","volume":"51","author":"D Bawden","year":"1999","journal-title":"Aslib Proc"},{"key":"ref12","volume-title":"The Managing of Organizations: The Administrative Struggle","author":"B Gross","year":"1964"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/0885066614558015","article-title":"The effect of an electronic checklist on critical care provider workload, errors, and performance","volume":"31","author":"C Thongprayoon","year":"2016","journal-title":"J Intensive Care Med"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.ijmedinf.2005.07.009","article-title":"Clinical cognition and biomedical informatics: issues of patient safety","volume":"74","author":"V L Patel","year":"2005","journal-title":"Int J Med Inform"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1197\/jamia.M2373","article-title":"The extent and importance of unintended consequences related to computerized provider order entry","volume":"14","author":"J S Ash","year":"2007","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10111-010-0141-8","article-title":"Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety","volume":"13","author":"R J Holden","year":"2011","journal-title":"Cogn Technol Work"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1097\/CCM.0b013e318287f0c0","article-title":"Data utilization for medical decision making at the time of patient admission to ICU","volume":"41","author":"B W Pickering","year":"2013","journal-title":"Crit Care Med"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"912","DOI":"10.4338\/ACI-2016-03-RA-0033","article-title":"Toward designing information display to support critical care. a qualitative contextual evaluation and visioning effort","volume":"7","author":"M C Wright","year":"2016","journal-title":"Appl Clin Inform"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"e249","DOI":"10.1136\/amiajnl-2013-002615","article-title":"Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings","volume":"21","author":"T G Kannampallil","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.artmed.2012.10.002","article-title":"Understanding the nature of information seeking behavior in critical care: implications for the design of health information technology","volume":"57","author":"T G Kannampallil","year":"2013","journal-title":"Artif Intell Med"},{"key":"ref22","first-page":"1874","article-title":"Knowledge crystallization and clinical priorities: evaluating how physicians collect and synthesize patient-related data","volume":"2014","author":"A H Pollack","year":"2014","journal-title":"AMIA Annu Symp Proc"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"116","DOI":"10.4338\/ACI-2009-12-CR-0027","article-title":"Novel representation of clinical information in the ICU: developing user interfaces which reduce information overload","volume":"1","author":"B W Pickering","year":"2010","journal-title":"Appl Clin Inform"},{"key":"ref24","first-page":"445","volume-title":"Guidelines","author":"C Ware","year":"2013"},{"key":"ref25","first-page":"119","volume-title":"Advancing critical care in the ICU: a human-centered biomedical data visualization system","author":"A Faiola","year":"2011"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1055\/s-0038-1634202","article-title":"Support for fast comprehension of ICU data: visualization using metaphor graphics","volume":"40","author":"W Horn","year":"2001","journal-title":"Methods Inf Med"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.artmed.2010.02.001","article-title":"Intelligent visualization and exploration of time-oriented data of multiple patients","volume":"49","author":"D Klimov","year":"2010","journal-title":"Artif Intell Med"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0933-3657(00)00105-6","article-title":"Visualization and interactive analysis of blood parameters with InfoZoom","volume":"22","author":"M Spenke","year":"2001","journal-title":"Artif Intell 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Proc"},{"issue":"06","key":"ref34","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1136\/amiajnl-2012-000901","article-title":"Clinical documentation: composition or synthesis?","volume":"19","author":"L Mamykina","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.artmed.2005.03.001","article-title":"Distributed, intelligent, interactive visualization and exploration of time-oriented clinical data and their abstractions","volume":"38","author":"Y Shahar","year":"2006","journal-title":"Artif Intell Med"},{"key":"ref36","first-page":"599","article-title":"Beyond copy and paste: clinician approaches to meeting information needs during note writing","volume":"205","author":"Y Senathirajah","year":"2014","journal-title":"Stud Health Technol 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Karsh","year":"2006","journal-title":"Qual Saf Health Care"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1109\/MPER.1988.587534","article-title":"The visual display of quantitative information","volume":"8","author":"E R Tufte","year":"1988","journal-title":"IEEE Power Eng Rev"},{"issue":"05","key":"ref46","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1111\/j.1365-2648.2007.04365.x","article-title":"Qualitative data analysis: an introduction","volume":"59","author":"M Kzillen","year":"2007","journal-title":"J Adv Nurs"},{"issue":"03","key":"ref48","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"M L McHugh","year":"2012","journal-title":"Biochem Med (Zagreb)"},{"key":"ref51","first-page":"60","article-title":"Applying a participatory design approach to define objectives and properties of a \u201cdata profiling\u201d tool for electronic health data","volume":"2016","author":"H Estiri","year":"2016","journal-title":"AMIA Jt Summits Transl Sci Proc"},{"issue":"01","key":"ref52","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jbi.2004.11.006","article-title":"Using qualitative studies to improve the usability of an EMR","volume":"38","author":"A F Rose","year":"2005","journal-title":"J Biomed Inform"},{"key":"ref54","volume-title":"Naturalistic Inquiry. Vol 5","author":"Y S Lincoln","year":"1985"},{"issue":"03","key":"ref56","doi-asserted-by":"crossref","first-page":"682","DOI":"10.4338\/ACI-2016-02-RA-0030","article-title":"Provider use of a novel EHR display in the pediatric intensive care unit. large customizable interactive monitor (LCIM)","volume":"7","author":"O Asan","year":"2016","journal-title":"Appl Clin Inform"},{"key":"ref57","author":"K Zheng","year":"2015"},{"issue":"05","key":"ref58","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1109\/TVCG.2010.84","article-title":"How can visual analytics assist investigative analysis? Design implications from an evaluation","volume":"17","author":"C G\u00f6rg","year":"2011","journal-title":"IEEE Trans Vis Comput Graph"},{"issue":"12","key":"ref59","doi-asserted-by":"crossref","first-page":"e331","DOI":"10.1016\/j.ijmedinf.2013.01.009","article-title":"Using a sociotechnical framework to understand adaptations in health IT implementation","volume":"82","author":"L L Novak","year":"2013","journal-title":"Int J Med Inform"},{"issue":"05","key":"ref60","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1197\/jamia.M1061","article-title":"Improving patient safety by identifying side effects from introducing bar coding in medication administration","volume":"9","author":"E S Patterson","year":"2002","journal-title":"J Am Med Inform Assoc"},{"issue":"04","key":"ref61","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1197\/jamia.M2616","article-title":"Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety","volume":"15","author":"R Koppel","year":"2008","journal-title":"J Am Med Inform Assoc"},{"key":"ref62","first-page":"1AD:33","volume-title":"Interactive sociotechnical analysis","author":"M I Harrison"},{"issue":"04","key":"ref63","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1136\/qshc.2009.033282","article-title":"Interruptions and distractions in healthcare: review and reappraisal","volume":"19","author":"A J Rivera-Rodriguez","year":"2010","journal-title":"Qual Saf Health Care"},{"key":"ref64","first-page":"201","volume-title":"Human decision makers and automated decision aids: made for each other?","author":"K L Mosier","year":"1996"},{"issue":"06","key":"ref65","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1136\/amiajnl-2013-002627","article-title":"How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use","volume":"21","author":"J S Ancker","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"02","key":"ref67","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijmedinf.2014.10.001","article-title":"Dashboards for improving patient care: review of the literature","volume":"84","author":"D Dowding","year":"2015","journal-title":"Int J Med Inform"},{"issue":"03","key":"ref69","doi-asserted-by":"crossref","first-page":"e14002","DOI":"10.2196\/14002","article-title":"Design and prestudy assessment of a dashboard for presenting self-collected health data of patients with diabetes to clinicians: Iterative approach and qualitative case study","volume":"4","author":"A Giordanengo","year":"2019","journal-title":"JMIR Diabetes"},{"key":"ref72","volume-title":"Usability Engineering","author":"J Nielsen","year":"1994"},{"issue":"02","key":"ref73","doi-asserted-by":"crossref","first-page":"e88","DOI":"10.1055\/s-0039-1697907","article-title":"Patient-Specific Explanations for Predictions of Clinical Outcomes","volume":"03","author":"M Tajgardoon","year":"2019","journal-title":"ACI Open"},{"issue":"03","key":"ref74","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1055\/s-0038-1666842","article-title":"The development of heuristics for evaluation of dashboard visualizations","volume":"9","author":"D Dowding","year":"2018","journal-title":"Appl Clin Inform"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1709707.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T22:12:15Z","timestamp":1617919935000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1709707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":57,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2020,8,5]]},"published-print":{"date-parts":[[2020,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1709707","relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]}}}