Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress NotesFunding This work was supported by the Agency for Healthcare Research and Quality Award R01HS022085 (to G.M.) and National Science Foundation Award CMMI-1150057 (to J.M.).
25 January 2019
26 April 2019
19 June 2019 (online)
Background High-quality clinical notes are essential to effective clinical communication. However, electronic clinical notes are often long, difficult to review, and contain information that is potentially extraneous or out of date. Additionally, many clinicians write electronic clinical notes using customized templates, resulting in notes with significant variability in structure. There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences.
Objective This article aims to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns.
Materials and Methods We conducted an experiment utilizing an electronic health record (EHR) system prototype containing four anonymized patient cases, each composed of nine progress notes that were presented with note sections organized in different orders to different subjects (i.e., Subjective, Objective, Assessment, and Plan, Assessment, Plan, Subjective, and Objective, Subjective, Assessment, Objective, and Plan, and Mixed). Participants, who were mid-level residents and fellows, reviewed the cases and provided a brief summary after reviewing each case. Time-related data were collected and analyzed using descriptive statistics. Surveys were administered and interviews regarding experiences reviewing notes were collected and analyzed qualitatively.
Results Qualitatively, participants reported challenges related to reviewing electronic clinical notes. Experimentally, time spent reviewing notes varied based on the note section organization. Consistency in note section organization improved performance (e.g., less scrolling and searching) compared with Mixed section organization when reviewing progress notes.
Discussion Clinicians face significant challenges reviewing electronic clinical notes. Our findings support minimizing extraneous information in notes, removing information that can be found in other parts of the EHR, and standardizing the display and order of note sections to improve clinicians' note review experience.
Conclusion Our findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.
Keywordselectronic health records and systems - clinical documentation and communication - qualitative methods - workflow - sociotechnical aspects of information technology
Protection of Human and Animal Subjects
This study was performed in compliance with World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. This work was reviewed by the University of Minnesota Institutional Review Board.
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