- Showing less data in physician EHR notes may produce more benefits for physician productivity, according to a recent study published in the Journal of the American Board of Family Medicine (JABFM).
The study by Jeffery Beldon, MD et al. compared different physician EHR note designs to see which design physicians found most efficient, accurate, and usable when attempting to obtain information for ambulatory chronic disease care.
Researchers devised four physician note designs and tested the designs on 16 primary care physicians in random order. Physicians were instructed to find key information in the EHR notes during timed tasks.
Physicians then gave each note design a usability rating and new feature preference rating. Additionally, researchers conducted interviews with physicians to gain insight into the physicans’ experiences using each note design.
“Cluttered documentation may contribute adversely to physician readers’ cognitive load, inadvertently obscuring high-value information with less valuable information,” researchers wrote in the report.
In an effort to reduce clutter and enable physicians to quickly find the most relevant and significant clinical information, physicians designed a collapsible note that displayed assessment, plan, subjective, and objective (APSO) information to physicians. Researchers provided clinicians with three variations on the new APSO prototype. This new design contrasted the traditional subjective, objective, assessment, and plan (SOAP) EHR note.
Ultimately, researchers found physicians preferred the new collapsible APSO note design over the traditional SOAP version. The APSO note prototype performed better for physicians in speed, accuracy, and task load categories.
“Users strongly endorsed all the new note features incorporated into the new note prototypes,” stated researchers. “Previously expressed concerns about temporarily hiding parts of the note (using the accordion display design pattern) were allayed.”
Furthermore, physicians pointed to the traditionally-used SOAP EHR note as the least usable design. Given the prevalence of EHR usability problems across the industry, researchers suggested healthcare organizations make small adjustments to physician notes to easily reduce clinician burden and boost the efficiency of EHR notes.
“By far, the technologically simplest change is to move Assessment & Plan to the top of the note,” researchers explained. “This can readily be done with almost any existing EHR, either by the vendor or client information technology team or even by individual clinician users.”
Another simple EHR note modification that could boost clinical efficiency and EHR usability is using colored text and bold font to highlight abnormal information.
These and other EHR note changes could assist in improving EHR usability and reducing clinician burden at healthcare organizations without requiring health IT companies to innovate new EHR system offerings. While health IT innovators should aim to improve EHR usability to streamline work for clinicians, healthcare organizations can also make small changes to improve usability themselves.
“APSO notes would be simple and inexpensive to implement for most organizations, as would adding emphasis to abnormal elements with selective use of color and typography,” maintained researchers.
Hiding some less relevant data in EHR notes could also help to avoid overwhelming physicians with an abundance of scattered information. Cluttered, unnecessary information often clouds EHR notes when physicians use the copy-paste functionality during clinical documentation. Using the copy-paste functionality can lead to the appearance of repetitive, redundant, and non-specific information in physician notes.
“Using these same human factors principles in other aspects of information transfer, such as in computerized order entry or in clinical decision support, might reduce clinicians’ burden further, and deserves systematic exploration,” suggested researchers.
Reducing clinician burden could also help to lessen the risk of physician burnout.
“The next step is to incorporate as many features as feasible into the local implementation of our commercial EHR,” the team concluded.