Appl Clin Inform 2019; 10(03): 446-453
DOI: 10.1055/s-0039-1692164
Research Article
Georg Thieme Verlag KG Stuttgart · New York

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

Gretchen M. Hultman
1   Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
Jenna L. Marquard
2   College of Engineering, University of Massachusetts, Amherst, Massachusetts, United States
Elizabeth Lindemann
3   Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
Elliot Arsoniadis
1   Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
3   Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
Serguei Pakhomov
1   Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
4   College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States
Genevieve B. Melton
1   Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
3   Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
› Author Affiliations
Funding This work was supported by the Agency for Healthcare Research and Quality Award R01HS022085 (to G.M.) and National Science Foundation Award CMMI-1150057 (to J.M.).
Further Information

Publication History

25 January 2019

26 April 2019

Publication Date:
19 June 2019 (online)


Background High-quality clinical notes are essential to effective clinical communication. However, electronic clinical notes are often long, difficult to review, and contain information that is potentially extraneous or out of date. Additionally, many clinicians write electronic clinical notes using customized templates, resulting in notes with significant variability in structure. There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences.

Objective This article aims to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns.

Materials and Methods We conducted an experiment utilizing an electronic health record (EHR) system prototype containing four anonymized patient cases, each composed of nine progress notes that were presented with note sections organized in different orders to different subjects (i.e., Subjective, Objective, Assessment, and Plan, Assessment, Plan, Subjective, and Objective, Subjective, Assessment, Objective, and Plan, and Mixed). Participants, who were mid-level residents and fellows, reviewed the cases and provided a brief summary after reviewing each case. Time-related data were collected and analyzed using descriptive statistics. Surveys were administered and interviews regarding experiences reviewing notes were collected and analyzed qualitatively.

Results Qualitatively, participants reported challenges related to reviewing electronic clinical notes. Experimentally, time spent reviewing notes varied based on the note section organization. Consistency in note section organization improved performance (e.g., less scrolling and searching) compared with Mixed section organization when reviewing progress notes.

Discussion Clinicians face significant challenges reviewing electronic clinical notes. Our findings support minimizing extraneous information in notes, removing information that can be found in other parts of the EHR, and standardizing the display and order of note sections to improve clinicians' note review experience.

Conclusion Our findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.

Protection of Human and Animal Subjects

This study was performed in compliance with World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. This work was reviewed by the University of Minnesota Institutional Review Board.

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