EHR notes with less clinical information increase physician efficiency

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Electronic health records (EHRs) that display less clinically relevant information could be more accurate and more satisfying for physicians, according to a study published in the Journal of the American Board of Family Medicine.

The cluttered documentation of EHRs leaves physicians in a position where they must review records and take their attention away from patients, leaving patients feeling left out while physicians are burdened with information. In response, researchers developed the assessment, plan, subjective, objective (APSO) note design of EHRs to improve efficiency and increase accuracy of physicians. This study examined the differences in speed, satisfaction and accuracy of the APSO design versus the conventional subjective, objective, assessment, plan (SOAP) note display.

Overall, four note designs were created and tested on 16 primary care physicians. Three of the designs created were in the APSO style and the fourth was a SOAP control design. Researchers simulated a clinical practice experience by imposing a time limit for physicians to work with the designs and collected pre- and post-task data.

Results showed that physicians preferred the APSOs to the traditional SOAP design. Additionally, physicians were able to function more quickly and more accurately with the APSO design.

“By far, the technologically simplest change is to move Assessment & Plan to the top of the note. 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,” concluded first author Jeffery Beldon, MD and colleagues. “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. The next step is to incorporate as many features as feasible into the local implementation of our commercial EHR.”