A Prescription for Note Bloat: An Effective Progress Note Template

Kahn, Daniel; Stewart, Edward T.; Duncan, Mark D.; Lee, Edward; Simon, Wendy; Lee, Clement; Friedman, Jodi; Mosher, Hilary J.; Harris, Kerry F.; Bell, Julia A.; Sharpe, Bradley A.; El-Farra, Neveen

doi:10.12788/jhm.2898

Cited by 47 publications

(51 citation statements)

References 24 publications

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“…In addition, user composability requires proper training techniques with implementation in order to maximize its potential. 21 Changing the order of the clinical note may also improve usability 18,19 . Putting salient information at the beginning of the note may allow physicians to spend less time searching through extraneous information, and thus reduce the cognitive burden.…”

Section: Discussionmentioning

confidence: 99%

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Patient safety issues from information overload in electronic medical records: A systematic review

Nijor¹,

Gokcen²,

Lad³

2020

Preprint

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Background and Objective: Electronic health records (EHR) have become ubiquitous in medicine and continue to grow in informational content. Little has been documented regarding patient safety from the resultant information overload. The objective of this literature review is to better understand how information overload in EHR affects patient safety.Methods: A literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards for literature review. PubMed and Web of Science were searched and articles selected that were relevant to EHR information overload based upon keywords. Results: The literature search yielded 31 articles meeting criteria for the study. Information overload was found to increase physician cognitive load and error rates in clinical simulations. Overabundance of clinically irrelevant information, poor data display, and excessive alerting were consistently identified as issues that may lead to information overload. An addition, information overload increased the risk of physician burnout due to clerical burden leading to significantly higher rates of medical error. Conclusion: Information overload in EHR may result in higher error rates and negatively impact patient safety. Further studies are necessary to define the EHR role in adverse patient safety events and to determine methods to mitigate these errors.

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Section: Discussionmentioning

confidence: 99%

“…Information overload can also be mitigated through educating physicians to write more efficient notes. Kahn et al 19 demonstrated that physicians who undergo a training session and use a template write notes that are 25% shorter and take 1.3 hours less time.…”

Section: The Cognitive Burden Of Information Overloadmentioning

confidence: 99%

Patient safety issues from information overload in electronic medical records: A systematic review

Nijor¹,

Gokcen²,

Lad³

2020

Preprint

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“…38 A few studies have attempted educational interventions that successfully have increased the quality of progress notes while decreasing note length. 39,40 These studies show promise, but more direct changes in regulation and EHR design may be desirable in the long term.…”

Section: Discussionmentioning

confidence: 99%

Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

et al. 2019

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Purpose: With the current wide adoption of electronic health records (EHRs) by ophthalmologists, there are widespread concerns about the amount of time spent using the EHR. The goal of this study was to examine how the amount of time spent using EHRs as well as related documentation behaviors changed 1 decade after EHR adoption. Design: Single-center cohort study. Participants: Six hundred eighty-five thousand three hundred sixty-one office visits with 70 ophthalmology providers. Methods: We calculated time spent using the EHR associated with each individual office visit using EHR audit logs and determined chart closure times and progress note length from secondary EHR data. We tracked and modeled how these metrics changed from 2006 to 2016 with linear mixed models. Main Outcome Measures: Minutes spent using the EHR associated with an office visit, chart closure time in hours from the office visit check-in time, and progress note length in characters. Results: Median EHR time per office visit in 2006 was 4.2 minutes (interquartile range [IQR], 3.5 minutes), and increased to 6.4 minutes (IQR, 4.5 minutes) in 2016. Median chart closure time

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“…The sample size of our study was comparable with that of prior psychometric validation studies. 33,34 Upon reviewing the A&Ps associated with these admissions, 365 notes were excluded for one of three reasons: (1) the note was written by a nurse practitioner, physician assistant, resident, or medical student; (2) the admission diagnosis had been definitively confirmed in the emergency department (eg, abdominal pain due to diverticulitis seen on CT); and (3) the note represented the fourth or more note by any single provider (to sample notes of many providers, no more than three notes written by any single provider were analyzed). A total of 285 admission notes were ultimately included in the sample.…”

Section: Data Collectionmentioning

confidence: 99%

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric

Kotwal

Klimpl

Tackett

et al. 2019

Journal of Hospital Medicine

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OBJECTIVE: To establish a metric for evaluating hospitalists’ documentation of clinical reasoning in admission notes. STUDY DESIGN: Retrospective study. SETTING: Admissions from 2014 to 2017 at three hospitals in Maryland. PARTICIPANTS: Hospitalist physicians. MEASUREMENTS: A subset of patients admitted with fever, syncope/dizziness, or abdominal pain were randomly selected. The nine-item Clinical Reasoning in Admission Note Assessment & Plan (CRANAPL) tool was developed to assess the comprehensiveness of clinical reasoning documented in the assessment and plans (A&Ps) of admission notes. Two authors scored all A&Ps by using this tool. A&Ps with global clinical reasoning and global readability/clarity measures were also scored. All data were deidentified prior to scoring. RESULTS: The 285 admission notes that were evaluated were authored by 120 hospitalists. The mean total CRANAPL score given by both raters was 6.4 (SD 2.2). The intraclass correlation measuring interrater reliability for the total CRANAPL score was 0.83 (95% CI, 0.76-0.87). Associations between the CRANAPL total score and global clinical reasoning score and global readability/clarity measures were statistically significant (P < .001). Notes from academic hospitals had higher CRANAPL scores (7.4 [SD 2.0] and 6.6 [SD 2.1]) than those from the community hospital (5.2 [SD 1.9]), P < .001. CONCLUSIONS: This study represents the first step to characterizing clinical reasoning documentation in hospital medicine. With some validity evidence established for the CRANAPL tool, it may be possible to assess the documentation of clinical reasoning by hospitalists.

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A Prescription for Note Bloat: An Effective Progress Note Template

Abstract: The bundled intervention for progress notes significantly improved the quality, decreased the length, and resulted in earlier note completion across 4 academic medical centers.

Cited by 47 publications

References 24 publications

Patient safety issues from information overload in electronic medical records: A systematic review

Patient safety issues from information overload in electronic medical records: A systematic review

Changes in Electronic Health Record Use Time and Documentation over the Course of a Decade

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric

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