Analysis of the information needs of primary care physicians in an electronic health record (EHR)
BACKGROUND: With the increase in the adoption of electronic health records (EHR) across the US, clinicians are experiencing information overload. In order to address the problem of information overload, an assessment of the information needs of clinicians will assist in understanding what the clinicians view as useful information to make patient care more efficient. AIM: The purpose of this study is to understand the information display needs of primary care physicians in an electronic health record (EHR). METHOD: A systematic review of studies was conducted with a comprehensive search in PubMed, CINAHL, SCOPUS, references from relevant papers and hand-searched articles were examined to identify articles applicable to this review. An interdisciplinary team conceptualized nine interview questions over weekly group sessions and fictitious but typical acute and chronic physician's documentation (progress notes) was created by two family medicine physicians (JLB and RJK). An analysis of hour long semi-structured interviews was conducted with a sample size of 15 primary care physicians from the University Missouri health clinics in Columbia, MO. Participants were instructed to think aloud while identifying by highlighting with markers the key pieces of information in the note that are most relevant to their information needs during guided review of the progress notes Data analysis was conducted with the assistance of NVivo by coding transcripts and progress notes in order to run queries. RESULTS: Of the papers reviewed, the most common information needs found among clinicians were related to diagnoses, drug(s), and treatment/therapy. Colleagues remain a preferred information source among clinicians; however, a rise in Internet usage is apparent. Results from the study, shows that History of Present Illness, Assessment and Plan were the more frequently identified sections of a progress note by primary care physicians across all three scenarios and Review of Systems was frequently identified as a section in the note that is generally more than needed. Physicians view the Review of Systems as a billing requirement and not a useful part of a progress note for patient care. For Past Medical History, Temperature and Chest were highlighted as important in an acute visit because of the nature of the visit being for a cough while Problems, Smoking Habits, and Medications were highlighted more frequently on a chronic disease note possibly because of the nature of the visit being a follow up for diabetes and other problems. Although Allergies and Medications are closely related, Allergies was not identified as an important part of Past Medical History. Results show that physicians highlighted less information when it was their note and their patient than when they were viewing their partner's note and seeing their partner's patient. CONCLUSIONS: These results from this study can assist electronic health record vendors on how best to create progress notes for physicians to use effectively. Future plans for this project includes: coding interview transcripts, expanding research for transferability by integrating results from other user groups (patients and auditors), presenting the developed prototypes to stakeholders through focus groups and apply usability inspection methods to evaluate user interaction with newly designed prototype, and expanding the scope of the work to include specialists, nurses, pediatrics and all different patient types.
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