Primary care physicians' use of an electronic medical record system: A cognitive task analysis

Aviv Shachak*, Michal Hadas-Dayagi, Amitai Ziv, Shmuel Reis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

142 Scopus citations


OBJECTIVE: To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. DESIGN: Cognitive task analysis using semi-structured interviews and field observations. PARTICIPANTS: Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. RESULTS: The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped. CONCLUSIONS: There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.

Original languageAmerican English
Pages (from-to)341-348
Number of pages8
JournalJournal of General Internal Medicine
Issue number3
StatePublished - Mar 2009
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgements: We would like to thank the primary care physicians who took part in the study. We also greatly appreciate the administrative assistance of Mrs. Ivette Trujillo-Mordetzki. The first author was supported by a fellowship from the Israel Council of Higher Education and Galil Center. This study was supported by a research grant from Israel National Institute of Health Policy and Health Services Research. Roshtov, an EMR vendor, provided their platform (which is used by our study participants) for the research team to examine during the development of the research protocol and analysis of findings. Preliminary results of this study were presented at the annual meeting of the Israeli Association for Information Systems (ILAIS), 2006, and at Human Factors Engineering in Health Informatics conference, Arhus, Denmark, 2007.


  • Cognitive task analysis
  • Electronic Medical Record (EMR)
  • Primary care physician


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