Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

Abstract

OCCUPATIONAL APPLICATIONS When comparing a typical exam room layout to the Department of Veterans Affairs (VA's) new exam room design, with respect to the exam room computing, primary care providers experienced significantly less mental workload and greater situation awareness when using the new exam room design. Further, providers rated the new exam room layout significantly higher in terms of being integrated with their clinical workflow and spent significantly more time in screen sharing activities with the patient. A more thoughtful design of the exam room layout with respect to the placement and physical design of the computing set-up may reduce provider cognitive effort and enhance aspects of patient centeredness by viewing the computer and electronic health record (EHR) it displays as an important mediator between provider and patient. This was achieved by using an all-in-one computer attached to a wall mount that moves the monitor along three axes, allowing for optimal screen positioning and adjustable depending upon the scenario. TECHNICAL ABSTRACT Background: Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose: Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods: In a lab-based experiment, 28 providers used prototypes of the new and older "legacy" outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results: There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions: Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old "legacy" layout. A thoughtful design of the exam room with respect to the computing may positively impact providers' workload, situation awareness, time spent in screen sharing activities, and workflow integration.