Information Prioritization and Reading Patterns in Electronic Health Record Nursing Summaries: An Eye-Tracking Case Study

Objectives While nursing summaries in electronic health records are used for initial orientation to a patient’s status, research on nurses’ use of these summaries remains scarce. This case study conducted an eye-tracking simulation to identify (1) key information types (orders, vital signs, etc.), (2) frequently paired information types, and (3) common sequential patterns of information types within nursing summaries as nurses review simulated patient cases. Methods We recruited 33 medical-surgical nurses from a university hospital. As part of an eye-tracking simulation, they reviewed three simulated patients’ nursing summaries. A screen-based eye-tracker was used to capture participants’ gaze fixation on different information types. For analysis, we used discrete-time Markov chains and sequential pattern mining. Results The average total gaze fixation time was 1.77 minutes from 26 analyzed participants’ eye gaze data. Most of this time was spent shifting between information types or making notes. “Orders” and “Sidebar” (mini summary of demographics and health status) were the information types that consistently emerged as key areas of focus. Participants tended to read specific information types in pairs and followed a top-to-bottom order of reading on the screen. Conclusion When reviewing unfamiliar patient cases, nurses prefer to construct a comprehensive patient narrative. Nursing summaries can be redesigned by prioritizing key information types, grouping relevant information pairs, and arranging information in a top-to-bottom manner based on relevance. We recommend that hospitals and EHR vendors prioritize the customization of nursing summaries to align with nurses’ information needs and workflows. Tailored summary layout improvements beyond a one-size-fits-all design, informed by interdisciplinary collaboration, can enhance information reading efficiency.