title: Writing and reading in the electronic health record: an entirely new world.
abstract: BACKGROUND
  Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence.
  
  
  OBJECTIVE
  This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference.
  
  
  METHODS
  Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions.
  
  
  RESULTS
  Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001).
  
  
  CONCLUSIONS
  Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.
authors: Department of Medical Education, Southern Illinois University School of Medicine, IL, USA. hhan@siumed.edu
authors: Heeyoung
authors: H
authors: Han
authors: Lauri
authors: L
authors: Lopp
mesh_terms: D001292:Attitude to Computers; D002983:Clinical Competence; D057286:Electronic Health Records; D006801:Humans; D010820:Physicians; D011932:Reading; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States; D014956:Writing
keywords: documentation; electronic health record (EHR); electronic medical record (EMR); navigation; reading
references: J Am Med Inform Assoc. 2012 Jul-Aug;19(4):537-40
references: 22517802
references: J Am Med Inform Assoc. 2009 Mar-Apr;16(2):228-37
references: 19074301
references: Fam Med. 2012 Jun;44(6):387-95
references: 22733415
references: Healthc Financ Manage. 2011 Mar;65(3):130, 132
references: 21449314
references: Med Educ. 2010 Nov;44(11):1132-3
references: 20946497
references: Am J Health Behav. 2010 Jan-Feb;34(1):3-11
references: 19663746
references: Teach Learn Med. 2012;24(2):106-10
references: 22490089
references: Health Aff (Millwood). 2006 Nov-Dec;25(6):w496-507
references: 17035341
references: Int J Med Inform. 2011 Aug;80(8):e141-9
references: 20974549
references: J Am Med Inform Assoc. 2011 Mar-Apr;18(2):169-72
references: 21292703
references: NCHS Data Brief. 2012 Jul;(98):1-8
references: 23050588
references: N Engl J Med. 2008 Jul 3;359(1):50-60
references: 18565855
references: J AHIMA. 2003 Feb;74(2):68, 70
references: 12600176
references: J Am Med Inform Assoc. 2010 Jan-Feb;17(1):108-11
references: 20064811
references: J Gen Intern Med. 2010 Mar;25(3):177-85
references: 20033621
references: J Med Syst. 2012 Jun;36(3):1229-34
references: 20878212
references: Med J Aust. 2009 Jun 1;190(S11):S125-7
references: 19485860
references: Teach Learn Med. 2012;24(3):257-66
references: 22775791
references: Teach Learn Med. 2012;24(3):219-24
references: 22775785
references: Perspect Health Inf Manag. 2011 Apr 01;8:1b
references: 21464859
references: J Biomed Inform. 2007 Apr;40(2):106-13
references: 16904384
references: Natl Health Stat Report. 2010 Mar 31;(23):1-11
references: 20632518
references: J Med Internet Res. 2011 May 27;13(2):e40
references: 21622292
references: J Am Med Inform Assoc. 2011 Dec;18 Suppl 1:i87-90
references: 21900702
references: J Am Med Inform Assoc. 2011 Mar-Apr;18(2):181-6
references: 21233086
references: Biol Psychiatry. 1998 Oct 15;44(8):775-7
references: 9798082
references: BMC Med Inform Decis Mak. 2010 Oct 15;10:60
references: 20950458
references: Adv Health Sci Educ Theory Pract. 2004;9(1):47-60
references: 14739761