Information Chaos in the Electronic Health Record as a Threat to Patient Safety

Information chaos refers to the chaotic presentation and subsequent suboptimal reception of information in the electronic health record (EHR). Prior work in ambulatory settings identified a group of hazards that were described collectively as information chaos. These hazards include information overload, information underload, information conflict, information scatter, and erroneous information. This pilot project examined four inpatient EHR records in a pediatric intensive care unit (PICU) to investigate whether information chaos was present. All four patient charts revealed numerous information hazards, suggesting the presence of information chaos within PICU patient charts. All charts demonstrated information chaos and information overload. We also identified three novel hazards: non-intuitive abbreviations, non-intuitive access of information, and copy & paste. Information chaos may confound information intake and processing, which raises mental workload and lowers situation awareness. Thus, PICU physicians may be at heightened risk for impaired performance of clinical tasks, which may jeopardize the safety of critically ill pediatric patients.