A framework for analyzing the cognitive complexity of computer-assisted clinical ordering

Jan Horsky, David R. Kaufman, Michael I. Oppenheim, Vimla L. Patel

Research output: Contribution to journalArticlepeer-review

100 Scopus citations


Computer-assisted provider order entry is a technology that is designed to expedite medical ordering and to reduce the frequency of preventable errors. This paper presents a multifaceted cognitive methodology for the characterization of cognitive demands of a medical information system. Our investigation was informed by the distributed resources (DR) model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This method evaluates the relative distribution of external (system) and internal (user) representations embodied in system interaction. We conducted an expert walkthrough evaluation of a commercial order entry system, followed by a simulated clinical ordering task performed by seven clinicians. The DR model was employed to explain variation in user performance and to characterize the relationship of resource distribution and ordering errors. The analysis revealed that the configuration of resources in this ordering application placed unnecessarily heavy cognitive demands on the user, especially on those who lacked a robust conceptual model of the system. The resources model also provided some insight into clinicians' interactive strategies and patterns of associated errors. Implications for user training and interface design based on the principles of human-computer interaction in the medical domain are discussed.

Original languageEnglish (US)
Pages (from-to)4-22
Number of pages19
JournalJournal of Biomedical Informatics
Issue number1-2
StatePublished - 2003
Externally publishedYes


  • Cognitive evaluation
  • Distributed cognition
  • Information systems
  • Medical errors
  • Provider order entry

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics


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