Beyond Notes: Why It Is Time to Abandon an Outdated Documentation Paradigm

Steinkamp, Jackson; Kantrowitz, Jacob; Sharma, Abhinav; Bala, Wasif

doi:10.2196/24179

Cited by 2 publications

(5 citation statements)

References 4 publications

(5 reference statements)

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“…This functionality allows updates to be made without requiring creation of a new document, while maintaining old documents for medicolegal purposes. Multiple such systems have been described and implemented in medical contexts, described as dynamic documentation or the wiki model, but have not yet been widely implemented.…”

Section: Discussionmentioning

confidence: 99%

“…Under the current system, to keep relevant information about a patient in a single, up-to-date document (ie, minimize scatter), a note author will need to continuously create copies of old notes and add to them, rather than just editing old documents in place. This practice directly contributes to textual duplication . Therefore, we cannot treat duplication in isolation, as unilateral restrictions on copy-paste behavior may exacerbate information scatter.…”

Section: Discussionmentioning

confidence: 99%

“…Adherence to the note paradigm leaves little room for modern software advances, such as document editing, collaborative documentation, or version history tracking, and contributes to 2 major documentation hazards common in modern EMRs: information overload and information scatter. 3,4 Information overload refers to the difficulty of finding relevant information because there is too much information in the EMR. 4 Information overload includes information duplication, when the same content is replicated throughout the EMR by copy-pasting, templating, and summarizing.…”

Section: Information Hazardsmentioning

confidence: 99%

“…This practice directly contributes to textual duplication. 3,22 Therefore, we cannot treat duplication in isolation, as unilateral restrictions on copy-paste behavior may exacerbate information scatter. Our study provides some evidence for this trade-off in our analysis of note lengths and novel text.…”

Section: Clinical Importancementioning

confidence: 99%

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Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Steinkamp

Kantrowitz²,

Airan-Javia

2022

JAMA Netw Open

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ImportanceDuplicated text is a well-documented hazard in electronic medical records (EMRs), leading to wasted clinician time, medical error, and burnout. This study hypothesizes that text duplication is prevalent and increases with time and EMR size and that duplicate information is shared across authors.ObjectiveTo examine the prevalence and scope of duplication behavior in clinical notes from a large academic health system and the factors associated with duplication.Design, Setting, and ParticipantsThis retrospective, cross-sectional analysis of note length and content duplication rates used a set of 10 adjacent word tokens (ie, a 10-gram) sliding-window approach to identify spans of text duplicated exactly from earlier notes in a patient’s record for all inpatient and outpatient notes written within the University of Pennsylvania Health System from January 1, 2015, through December 31, 2020. Text duplicated from a different author vs text duplicated from the same author was quantified. Furthermore, novel text and duplicated text per author for various note types and author types, as well as per patient record by number of notes in the record, were quantified. Information scatter, another documentation hazard, was defined as the inverse of novel text per note, and the association between information duplication and information scatter was graphed. Data analysis was performed from January to March 2022.Main Outcomes and MeasuresTotal, novel, and duplicate text by note type and note author were determined, as were the mean intra-author and inter-author duplication per note by type and author.ResultsThere were a total of 104 456 653 notes for 1 960 689 unique patients consisting of 32 991 489 889 words; 50.1% of the total text in the record (16 523 851 210 words) was duplicated from prior text written about the same patient. The duplication fraction increased year-over-year, from 33.0% for notes written in 2015 to 54.2% for notes written in 2020. Of the text duplicated, 54.1% came from text written by the same author, whereas 45.9% was duplicated from a different author. Records with more notes had more total duplicate text, approaching 60%. Note types with high information scatter tended to have low information overload, and vice versa, suggesting a trade-off between these 2 hazards under the current documentation paradigm.Conclusions and RelevanceDuplicate text casts doubt on the veracity of all information in the medical record, making it difficult to find and verify information in day-to-day clinical work. The findings of this cross-sectional study suggest that text duplication is a systemic hazard, requiring systemic interventions to fix, and simple solutions such as banning copy-paste may have unintended consequences, such as worsening information scatter. The note paradigm should be further examined as a major cause of duplication and scatter, and alternative paradigms should be evaluated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Information Hazardsmentioning

confidence: 99%

Section: Clinical Importancementioning

confidence: 99%

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Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Steinkamp

Kantrowitz²,

Airan-Javia

2022

JAMA Netw Open

Self Cite

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show abstract

“…Notes are a poor organizational framework for the individual clinician, but they may be even worse for a collaborative medical team. Although little of a patient's medical information changes depending on the team or physician reviewing it, different teams usually redocument the same information (e.g., the history of the present illness) in separate notes, representing another large source of duplicated information [31]. When information does differ between teams (e.g., different physical exam results or a more in-depth cardiological history), it can only be identified by navigating between separate notes.…”

Section: Interoperability Challenges In Digital Healthmentioning

confidence: 99%

Empowering rheumatology through digital health technologies: contributions and barriers

Benavent,

Carmona,

Llorente

et al. 2024

Explor Musculoskeletal Dis

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Rheumatology, the medical specialty dealing with the diagnosis and treatment of rheumatic and musculoskeletal diseases (RMDs), is evolving with the emergence of digital health technologies, such as electronic health records (EHRs), virtual visits, mobile health (mHealth), wearable medical devices, social media, websites, digital therapeutics, artificial intelligence (AI) and machine learning. These technologies offer new opportunities to improve essential aspects of care, such as care access or disease management. They can significantly reduce the risk of errors and the workload of rheumatologists, while enhancing communication between physicians and patients, resulting in better quality of care. Moreover, digital health technologies can significantly improve research outcomes. However, digital health technologies in rheumatology also face specific barriers such as privacy, security concerns, incremental costs as well as limited digital health literacy and access. Therefore, further analysis, actions and strategies are needed to overcome these barriers. This article explores the impact of digital health technologies on rheumatology practice and highlights their contributions and challenges. By understanding the immense potential and overcoming the obstacles, the way for a future where digital health technologies are integrated into daily rheumatology care may be envisioned, in order to empower patients and healthcare providers.

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Beyond Notes: Why It Is Time to Abandon an Outdated Documentation Paradigm

Cited by 2 publications

References 4 publications

Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Prevalence and Sources of Duplicate Information in the Electronic Medical Record

Empowering rheumatology through digital health technologies: contributions and barriers

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