Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes

Abstract

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clinical notes are often long, difficult to review, and contain information that is potentially extraneous or out of date.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.

Fig. 1

Self-reported note reading time. Participants reported their average, maximum, and minimum note reading times. The average time for each plotted and the whiskers represent the maximum and minimum reading time. The line represents the average of participants' average reading time.

Fig. 2

Value of information-types in notes. Participants were asked to list the five types of information they found most valuable and rank them 1–5. This bar chart shows the types of information mentioned and the color denotes its priority.

Fig. 3

Information barriers. Participants were asked to review six potential information barriers and rank how much of a barrier each is to note reading and rate each on a scale of 1–5, with 1 being not a barrier and 5 being a severe barrier.