Summary
Background: With the increase in the adoption of electronic health records (EHR) across the US,
primary care physicians are experiencing information overload. The purpose of this
pilot study was to determine the information needs of primary care physicians (PCPs)
as they review clinic visit notes to inform EHR display.
Method: Data collection was conducted with 15 primary care physicians during semi-structured
interviews, including a third party observer to control bias. Physicians reviewed
major sections of an artificial but typical acute and chronic care visit note to identify
the note sections that were relevant to their information needs. Statistical methods
used were McNemar-Mosteller’s and Cochran Q.
Results: Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P)
as the most important sections of a visit note. In contrast, they largely judged the
Review of Systems (ROS) to be superfluous. There was also a statistical difference
in physicians’ highlighting among all seven major note sections in acute (p = 0.00)
and chronic (p = 0.00) care visit notes.
Conclusion: A&P and HPI sections were most frequently identified as important which suggests
that physicians may have to identify a few key sections out of a long, unnecessarily
verbose visit note. ROS is viewed by doctors as mostly “not needed,” but can have
relevant information. The ROS can contain information needed for patient care when
other sections of the Visit note, such as the HPI, lack the relevant information.
Future studies should include producing a display that provides only relevant information
to increase physician efficiency at the point of care. Also, research on moving A&P
to the top of visit notes instead of having A&P at the bottom of the page is needed,
since those are usually the first sections physicians refer to and reviewing from
top to bottom may cause cognitive load.
Citation: Clarke MA, Steege LM, Moore JL, Koopman RJ, Belden JL, Kim MS. Determining primary
care physician information needs to inform ambulatory visit note display. Appl Clin
Inf 2014; 5: 169–190
http://dx.doi.org/10.4338/ACI-2013-08-RA-0064
Keywords
Primary Care Physicians - Information Seeking Behavior - Information Needs - Electronic
Health Record - Data Display - Attitude of Health Personnel - User-Computer Interface
