RT Journal Article
SR Electronic
T1 Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 316
OP 323
DO 10.3122/jabfm.2015.03.140244
VO 28
IS 3
A1 Richelle J. Koopman
A1 Linsey M. Barker Steege
A1 Joi L. Moore
A1 Martina A. Clarke
A1 Shannon M. Canfield
A1 Min S. Kim
A1 Jeffery L. Belden
YR 2015
UL http://www.jabfm.org/content/28/3/316.abstract
AB Background: Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. Methods: This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. Results: The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Conclusions: Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.