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

Hultman, Gretchen M.; Marquard, Jenna L.; Lindemann, Elizabeth; Arsoniadis, Elliot G.; Pakhomov, Serguei; Melton, Genevieve B.

doi:10.1055/s-0039-1692164

Cited by 23 publications

(17 citation statements)

References 23 publications

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“…One participant voiced this discontent particularly saliently, saying “Most of my work does not feel like I'm working as a doctor but more like a secretary.” To cope with this documentation burden and spread of information, observed physicians would often copy and paste previous information into their current notes, possibly limiting the impact of new information; copy/paste and “note bloat” problems are a well-known symptom of EHR use. 50 51 52 These findings could suggest that differences in regulations regarding documentation between different countries, while undoubtedly a major factor, might not be the primary driver of dissatisfaction with EHRs in general and documentation in particular, as has been suggested previously. 53…”

Section: Discussionsupporting

confidence: 51%

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

Hoop

Neumuth

2021

Appl Clin Inform

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Objectives This study set out to obtain a general profile of physician time expenditure and electronic health record (EHR) limitations in a large university medical center in Germany. We also aim to illustrate the merit of a tool allowing for easier capture and prioritization of specific clinical needs at the point of care for which the current study will inform development in subsequent work. Methods Nineteen physicians across six different departments participated in this study. Direct clinical observations were conducted with 13 out of 19 physicians for a total of 2,205 minutes, and semistructured interviews were conducted with all participants. During observations, time was measured for larger activity categories (searching information, reading information, documenting information, patient interaction, calling, and others). Semistructured interviews focused on perceived limitations, frustrations, and desired improvements regarding the EHR environment. Results Of the observed time, 37.1% was spent interacting with the health records (9.0% searching, 7.7% reading, and 20.5% writing), 28.0% was spent interacting with patients corrected for EHR use (26.9% of time in a patient's presence), 6.8% was spent calling, and 28.1% was spent on other activities. Major themes of discontent were a spread of patient information, high and often repeated documentation burden, poor integration of (new) information into workflow, limits in information exchange, and the impact of such problems on patient interaction. Physicians stated limited means to address such issues at the point of care. Conclusion In the study hospital, over one-third of physicians' time was spent interacting with the EHR, environment, with many aspects of used systems far from optimal and no convenient way for physicians to address issues as they occur at the point of care. A tool facilitating easier identification and registration of issues, as they occur, may aid in generating a more complete overview of limitations in the EHR environment.

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Section: Discussionsupporting

confidence: 51%

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

Hoop

Neumuth

2021

Appl Clin Inform

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“…However, little is known about how resident physicians' EHR usage specifically, or how it changes as they gain experience. [18][19][20][21] Residents may face a large EHR time burden as they attempt to quickly learn multiple systems at once, or it may be the case that young, technologically savvy residents are efficient in the EHR and are able to minimize their after-hours time. 22 While recent studies have shown variation across physician specialty, 23 there is little evidence to date about how physician EHR usage varies by experience or changes over time as they become more facile with the system.…”

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confidence: 99%

Resident Physician Experience and Duration of Electronic Health Record Use

2021

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Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

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“…For example, simply having clinical notes organized consistently can minimize the time clinicians spend reviewing them. 47 Interoperability of EHR systems (e.g., data collected from different health care institutions) is also an important factor to consider when looking at designing an EHR search function. If the search function can mine both data collected within the native-EHR system and data collected in another system, it may be useful to differentiate between those different data types when provided search results to users.…”

Section: Discussionmentioning

confidence: 99%

“…For example, simply having clinical notes organized consistently can minimize the time clinicians spend reviewing them. 47 …”

Section: Discussionmentioning

confidence: 99%

Use, Impact, Weaknesses, and Advanced Features of Search Functions for Clinical Use in Electronic Health Records: A Scoping Review

et al. 2021

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Objective Although vast amounts of patient information are captured in electronic health records (EHRs), effective clinical use of this information is challenging due to inadequate and inefficient access to it at the point of care. The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient's record in clinical settings to characterize the current state of research on the topic and identify areas for future study. Methods We conducted a literature search of four databases to identify articles on within-EHR search functions or the use of EHR search function in the context of clinical tasks. After reviewing titles and abstracts and performing a full-text review of selected articles, we included 17 articles in the analysis. We qualitatively identified themes in those articles and synthesized the literature for each theme. Results Based on the 17 articles analyzed, we delineated four themes: (1) how clinicians use search functions, (2) impact of search functions on clinical workflow, (3) weaknesses of current search functions, and (4) advanced search features. Our review found that search functions generally facilitate patient information retrieval by clinicians and are positively received by users. However, existing search functions have weaknesses, such as yielding false negatives and false positives, which can decrease trust in the results, and requiring a high cognitive load to perform an inclusive search of a patient's record. Conclusion Despite the widespread adoption of EHRs, only a limited number of articles describe the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity. Some of the weaknesses of current search functions may be addressed by enhancing EHR search functions with collaborative filtering.

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

Cited by 23 publications

References 23 publications

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

Resident Physician Experience and Duration of Electronic Health Record Use

Use, Impact, Weaknesses, and Advanced Features of Search Functions for Clinical Use in Electronic Health Records: A Scoping Review

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