Doctors Experiences of Interruptions in the Digital Age and the Impact on Clinical Care in England
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Objective
Interruptions are frequent in clinical care globally and associated with inefficiency, cognitive burden, and patient safety risks. Existing research into interruptions reflects paper-based workflows, and “digital distraction” studies often focus on personal device use. There is little research regarding interruptions produced by mandated digital infrastructures such as Electronic Health Records (EHRs) and clinical messaging platforms. This study aims to examine how mandated digital systems shape the form, experience, and meaning of interruptions in English outpatient care, and how doctors attempt to manage these demands.
Methods and Analysis
We conducted a qualitative analysis of focus group and interview data from a larger study of interruptions in outpatient care. Participants were 42 UK outpatient care doctors across specialties and experience levels, recruited via a screener survey and stratified into six groups based on experience level and self-reported patient complexity (trainee, 0-19 years, and 20+ years’ experience, each divided into high and low complexity). Data were analysed using Reflexive Thematic Analysis, with interpretation informed by the combined lens of Cognitive Load Theory and Social Identity theory; a pairing not previously applied together to interruptions, capturing both the cognitive and social-relational dimensions of digital interruptions. Analysis as structured deductively around these theories while remaining open to inductive, novel insights.
Results
Four themes captured digitally mediated interruption. Mandated systems normalised constant availability, making interruption a persistent condition of work. Digital tools acted as cognitive amplifiers, increasing extraneous cognitive load through fragmented interfaces, multi-window navigation, and technical unreliability, with perceived safety risks around patient-context switching. Digital coordination occurred without social cues, weakening visibility and contextual signals that support judgements of relevance, urgency, and responsibility, contributing to interpersonal friction. Doctors sought to reclaim control through individual strategies, including limiting exposure to channels and selectively embracing digital prompts where they supported safety or care quality.
Conclusion
Mandated digital infrastructures transform interruption into continuous, cognitively disruptive, and socially ambiguous demands. Mitigation requires system- and organisation-level solutions beyond individual workarounds.
Key Messages
What is already known on this topic
Interruptions are a known source of cognitive burden and safety risk in clinical care, but research has focused on paper-based workflows and personal device distraction, leaving interruptions from mandated systems like EHRs poorly understood.
What this study adds
This study shows mandated digital systems turn interruption into a constant background condition of work, increasing cognitive load through fragmented interfaces and weakening the social cues doctors rely on to judge urgency and responsibility.
How this study might affect research, practice or policy
As healthcare becomes increasingly digitally mediated, existing boundaries around availability, communication etiquette, and patient safety need to be revisited as an organisational priority, rather than a challenge for individual doctors to manage alone. This includes clearer digital communication norms and boundaries, safer alert and task-resumption design to reduce patient-context switching risk, and policies that formally protect time for cognitively demanding digital work.
