Limitations
anxiety
RECRUITMENT
Our study has some limitations that should be considered as study findings are interpreted. First, although our rigorous recruitment processes produced a nationally diverse population of RNs and important subgroups within, our overall response rate was low indicating potential selection bias. The age range of our participants was lower than the national statistics. The participating RNs may also be atypical in their interest in research in general and health information technology in particular. However, our participants may well represent the workforce 5 years from now and thus our outcomes once further validated will apply to the workforce of the day. Second, this study was conducted during the COVID-19 pandemic. The very high workload and stress placed on RNs might have had an impact on the response rate and on the representativeness of the participating RNs. Third, testing novel EHR features in a simulation environment provides important insight but is only one step toward improving EHR in a clinical setting. Fourth, RNs might have evaluation anxiety that affected how they interacted with the CDS system even though we took great care in the study to mitigate such anxiety. Fifth, RNs’ comfort with EHR was assessed with a single item and found to impact documentation time. Future studies are needed to validate this finding and to investigate the effect of an RN’s prior experience with CDS, which might be more relevant than comfort with EHR in general. Finally, we focused on matching CDS formats to RN characteristics. In clinical practice, it will also be important to take into account other characteristics that we have highlighted above when choosing data visualization formats.This study was supported by the National Institute of Nursing Research, National Institutes of Health (award R01 NR018416-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research and National Institutes of Health. The authors are grateful to Rishabh Garg for providing technical assistance.Conflicts of Interest: None declared.Example of hypothetical patient information and handoff directions shared with registered nurses (RNs) during the intervention.Nine clinical decision support recommendations in the study.CONSORT e-HEALTH checklist (V 1.6.1).