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

Abstract

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.

Too much versus too little: looking for the “sweet spot” in optimal use of diagnostic investigations

“…In general practice and emergency departments, up to one‐half of symptoms defy definitive diagnosis on first encounters 11 . Between 75% and 80% of such symptoms improve over four to 12 weeks, usually regardless of medical intervention 10 . Patients with “medically unexplained symptoms” should be spared exhaustive and fruitless testing for underlying rare diseases, and where normal results may still not allay patient discomfort and anxiety 12 .…”

“…Affording clinicians more time and support to adequately perform basic clinical tasks is paramount 9 . Re‐engineering electronic medical records and laboratory reporting systems to enable more efficient searching for past diagnosis lists and test results 10 could also reduce diagnostic confusion and unnecessary testing, especially repeat requests of the same test.…”

Evaluating the Impact on Clinical Task Efficiency of a Natural Language Processing Algorithm for Searching Medical Documents: Prospective Crossover Study

“…A large-scale retrospective analysis of searches performed in an EHR found that the use of search varied considerably across and within user roles, with physicians and pharmacists being the most active user groups [ 19 ]. A review of the use of search within EHRs found that few articles focused on the impact of search within clinical workflows [ 23 ]; one study with 7 diabetes experts found that content-based search was both faster and more accurate than conventional search for finding relevant information [ 20 ], another study with 10 family and internal medicine physicians found that semantic search allowed for faster medical notes navigation for IR tasks [ 21 ], and a final study with 4 students found that a semantic search tool enabled faster clinical note summarization [ 22 ]. Only one of the described studies [ 20 ] used a crossover study design.…”

Evaluating the impact on clinical task efficiency of a natural language processing algorithm for searching medical documents: Prospective crossover study

“…A large-scale retrospective analysis of searches performed in an EHR found that the use of search varied considerably across and within user roles, with physicians and pharmacists being the most active user groups [19]. A review of the use of search within EHRs found that few articles focussed on the impact of search within clinical workflows [23]; one study with 7 diabetes experts found that content-based search was both faster and more accurate than conventional search for finding relevant information [20], another study with 10 family and internal medicine physicians found that semantic search gave faster medical notes navigation for IR tasks [21], and a final study with 4 students found that a semantic search tool enabled faster clinical note summarisation [22]. Only one of the described studies [20] used a crossover study design.…”