Background Time is a measurable and critical resource that affects the quality of services provided in clinical practice. There is limited insight into the effects of time restrictions on clinicians’ cognitive processes with the electronic health record (EHR) in providing ambulatory care. Objective To understand the impact of time constraints on clinicians’ synthesis of text-based EHR clinical notes. Methods We used an established clinician cognitive framework based on a think-aloud protocol. We studied interns’ thought processes as they accomplished a set of four preformed ambulatory care clinical scenarios with and without time restrictions in a controlled setting. Results Interns most often synthesized details relevant to patients’ problems and treatment, regardless of whether or not the time available for task performance was restricted. In contrast to previous findings, subsequent information commonly synthesized by clinicians related most commonly to the chronology of clinical events for the unrestricted time observations and to investigative procedures for the time-restricted sessions. There was no significant difference in the mean number of omission errors and incorrect deductions when interns synthesized the EHR clinical notes with and without time restrictions (3.5±0.5 vs. 2.3±0.5, p =0.14). Conclusion Our results suggest that the incidence of errors during clinicians’ synthesis of EHR clinical notes is not increased with modest time restrictions, possibly due to effective adjustments of information processing strategies learned from the usual time-constrained nature of patient visits. Further research is required to investigate the effects of similar or more extreme time variations on cognitive processes employed with different levels of expertise, specialty, and with different care settings. 
Effects of time constraints on clinician–computer interaction: A study on information synthesis from EHR clinical notes