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Currently submitted to: JMIR Human Factors

Date Submitted: May 12, 2020
Open Peer Review Period: May 12, 2020 - May 26, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Characterizing and visualizing display and task fragmentation in the electronic health record: methodological approaches

  • Yalini Senathirajah; 
  • David R Kaufman; 
  • Kenrick D Cato; 
  • Elizabeth M. Borycki; 
  • Jaime Allen Fawcett; 
  • Andre W. Kushniruk; 



The complexity of healthcare data and workflows presents challenges to the study of usability in electronic health records (EHR). Display fragmentation refers to the distribution of relevant data across different screens, requiring complex navigation for the user’s workflow. Task and data source fragmentation also contributes to cognitive burden.


Define and analyze some of the main sources of fragmentation in EHR user interfaces, discuss relevant theoretical, historical and practical considerations, and employ granular microanalytic methods and visualization techniques to help us understand the nature of fragmentation and opportunities for EHR optimization or redesign.


Sunburst visualizations capture the EHR navigation structure, showing levels and sublevels of the navigation tree, allowing calculation of a new measure, the Display Fragmentation Index (DFI). Timebelt visualizations present the sequences of subtasks and allow calculation of a measure, PPI, that quantifies task fragmentation. These measures can be used separately or in conjunction, to compare EHRs as well as tasks and subtasks in workflows and identify opportunities for reductions in steps and fragmentation. We present an example use of the methods for comparison of two different EHR interfaces (commercial and composable) in which subjects apprehend the same patient case.


Screen transitions were substantially reduced for the composable interface (from 43 to 14) while clicks (including scrolling) remained similar.


These methods can aid in our understanding of user interface needs under complex conditions and tasks in order to optimize EHR workflows and redesign. Clinical Trial: The following is not a clinical trial.


Please cite as:

Senathirajah Y, Kaufman DR, Cato KD, Borycki EM, Fawcett JA, Kushniruk AW

Characterizing and visualizing display and task fragmentation in the electronic health record: methodological approaches

JMIR Preprints. 12/05/2020:18484

DOI: 10.2196/preprints.18484


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