Spatial Awareness Integrated EHR: Effects on Nurse Usability, Efficiency, and Cognitive Load

Abstract

Background: EHR usability challenges continue to impose cognitive strain and workflow inefficiencies on nurses in high-acuity settings. Poorly designed interfaces fragment data and increase documentation burden, contributing to fatigue and errors. Spatially aware EHRs (interfaces that visually align digital elements with the physical clinical environment) may enhance usability by promoting intuitive interaction, reducing mental effort, and improving accuracy and efficiency in nursing documentation.Purpose: This study evaluated how different EHR interface designs affect nurse usability, cognitive load, and documentation performance impact in simulated critical care settings. It aimed to compare the influence of interface design on task performance and cognitive burden for experienced ICU nurses. Methods: Thirty-six experienced ICU nurses participated in a randomized crossover study, completing standardized documentation tasks using both a Spatial Awareness Integrated Electronic Health Record (SAI) prototype and a linear interface design (LID). Paired t-tests and linear mixed-effects models analyzed within-subject differences. Quantitative measures included task completion time, accuracy, cognitive workload (NASA-TLX), usability (System Usability Scale [SUS]), perceived usefulness (TAM-PU), and behavioral intention to use (TAM-BI). Results: The SAI significantly reduced documentation time by 177 seconds per task (d = 0.88) and lowered NASA-TLX workload by about 19 points, exceeding the 10–15-point threshold considered practically meaningful. Accuracy rates were comparable across systems. Though not statistically significant, mean SUS scores favored SAI (77.99 ± 18.23) over LID (71.60 ± 20.82; p = .155). Perceived usefulness (TAM-PU) trended higher for SAI (3.72 ± 1.21 vs. 3.38 ± 1.14; p = .184). Behavioral intention (TAM-BI) was significantly greater for SAI (4.72 ± 0.93 vs. 3.76 ± 0.95; Δ = 0.96, 95% CI [0.55, 1.36]; p < .001; d = 0.72). Lower workload correlated with a stronger intention to adopt (r = – .64, p < .001). Conclusions: Spatially congruent interface design was associated with lower workload scores on the NASA-TLX, improved task efficiency, and higher ratings of usability and acceptance. By aligning the display with the clinical workspace and simplifying documentation pathways, spatially organized EHR layouts may help reduce documentation burden, enhance situational awareness, and support safer care in critical care environments.