Reducing cognitive load: The behavioural case for better EPR design
[BLOG]: By Dr Bishoy Dimitri, Emergency Medicine Clinician and CCIO, Dedalus
Dr Bishoy Dimitri, Emergency Medicine Clinician and CCIO, Dedalus
When every minute matters
A patient arrives with a fever, raised heart rate and confusion. I need to begin a sepsis screen immediately because every minute matters.
In a poorly designed electronic patient record, that can mean closing the form I am using, searching for the sepsis pathway, completing it and then finding my way back. Three or four screens and a dozen clicks later; the patient is still waiting and could be deteriorating.
This is not theoretical. I have encountered it in EPR systems across the NHS. Too often, systems follow technical logic rather than clinical reality. Good design should make the next action clear, without requiring clinicians to stop and work out how the system operates.
EPR statistics
The problem is design, not staff
Health Foundation research found that 64% of NHS staff said their EPR had added new tasks, while more than half said it had made work more difficult. This points to a gap between system design and care delivery.
Clinicians may be asked which features they want. However, what people request and use can differ. Most of us rely on a small proportion of the available functionality, choosing the quickest route to the information or action we need.
Suppliers and healthcare organisations therefore need to observe how work is carried out, including interruptions, time pressures and the need to make safe decisions quickly.
Training should support, not compensate
Training affects EPR adoption, but design remains fundamental. Fewer than half of NHS staff surveyed by the Health Foundation had received basic EPR training.
Training is essential for advanced functionality, but it should not be required for every routine task. Basic workflows should be clear enough to navigate with limited support.
On our ORBIS EPR, I can work out around 80% of what I need to do without training. A less experienced user could still complete around half unaided. Training should help people go further, rather than compensate for unclear design.
Ina Wechsung, Director User Experience, Dedalus
What good user experience looks like
Effective user experience design begins with understanding people, not technology. Approaches such as Stanford Design Thinking can help translate clinical workflows into usable, safe and context-aware digital tools.
The Dedalus UX team, headed by Ina Wechsung, is unique in that it uses cognitive psychology to understand how humans process information, while simultaneously observing clinical environments and working with users to design, test and refine workflows.
The team assesses these designs using the System Usability Scale (SUS),and uses customer satisfaction (CSAT) scores to understand how users experience its systems.
Learning from real clinical environments
A redesign of surgery scheduling demonstrates the value of looking beyond an individual screen. The team mapped the patient journey across registration, scheduling and anaesthesia, including the needs and jobs-to-be-done of all relevant stakeholders.
By ensuring every screen presents the right information at the right time, the team significantly reduced clinical cognitive effort, enabling users to spend more time and attention on the patient.
The redesigned workflow scored 89 out of 100 on the SUS; a remarkable improvement on the typical current EPR system score of 46. Dedalus demands a minimum SUS threshold of 65 for its systems. If a module does not meet the required threshold, it returns to development.
User satisfaction, as measured by CSAT, is an essential benchmark for Dedalus. Through composite measures including clinical outcomes, user experience and efficiency, ORBIS has regularly achieved a CSAT score of 90%.
Continuous engagement with users
The commitment to user-centred design continues. In the first half of 2026, the Dedalus UX team has conducted more than 100 user sessions, including hospital visits, workshops, interviews and user testing.
The team is also developing product analytics to understand real-world usage and guide improvements. Usability should be measured rather than assumed, with evidence showing where refinement is needed.
Why clinical realism and partnership matters
User-centred design is collaborative. Dedalus has value streams based on healthcare workflows, involves users in prototype evaluation and encourages frontline participation in procurement.
NHS Humber Health Partnership took this approach when almost 150 clinical and operational staff contributed to selecting ORBIS as its preferred EPR. Involving end users early can support better decisions and improve acceptance.
Healthcare organisations must improve productivity while maintaining safe, high-quality care. EPRs that demand less cognitive effort can give clinicians more capacity to speak with patients, identify risks and respond to change.
The question is not simply how quickly clinicians can be trained to use an EPR. It is how effectively the system supports them in doing what they trained for; caring for patients.