Table 3.

Focused recommendations for EHR design and implementation to support physician users in the medical ICU.^a

Topic	Finding	Recommendation
EHR navigation	Digital “information sprawl” is common during ICU pre-rounding, with key information scattered across different screens and windows Four screens serve as common “launch points” for electronic chart review in 50/52 cases Common transition patterns emerge across physician users performing chart review Despite common starting points, navigation pathways are highly variable during chart review across individuals	Prioritise screen consolidation by allowing users to select clinical data elements to create “data feeds” in one personalised, synthesised view (Choi et al., 2018). Facilitate split screens to reduce toggle burden and minimise back-tracking. Give visual prominence to these four screens and make them easiest to access right away (summary/overview, notes, results review, flowsheet) Facilitate common screen transitions via hyperlinks or button/tab positioning to support “jump to” navigation options Give physicians “protected time” to customise their EHR interface each year, supported by at-the-elbow-support staff (e.g. “superusers”), personalisation labs, or EHR “intervention teams” to improve physician user experience (Longhurst et al., 2019). Where available, utilise system-driven insights on most- and least-visited screens at the user level (e.g. audit log data) (Wang et al., 2019).
Core EHR design/configuration	Physicians rarely visit the vital signs tab during pre-rounds, but frequently visit the flowsheet Summary/overview screen is the second most visited screen during pre-rounding chart review	Change the default: Consider hiding the vital signs tab in the default ICU physician view to declutter the screen; give users the option to add it back Make user-driven customisation of summary/overview easy and intuitive. Solicit ICU physician end-user feedback for further enhancement; share “best practices” or macros at the institutional level

EHR: electronic health record; ICU: intensive care unit.

^a Recommendations are derived from live observation of ICU physician users (n = 6) but contextualised within the broader literature around EHR usability in other clinical settings.