title: Impact of a prototype visualization tool for new information in EHR clinical documents.
abstract: BACKGROUND
  EHR clinical document synthesis by clinicians may be time-consuming and error-prone due to the complex organization of narratives, excessive redundancy within documents, and, at times, inadvertent proliferation of data inconsistencies. Development of EHR systems that are easily adaptable to the user's work processes requires research into visualization techniques that can optimize information synthesis at the point of care.
  
  
  OBJECTIVE
  To evaluate the effect of a prototype visualization tool for clinically relevant new information on clinicians' synthesis of EHR clinical documents and to understand how the tool may support future designs of clinical document user interfaces.
  
  
  METHODS
  A mixed methods approach to analyze the impact of the visualization tool was used with a sample of eight medical interns as they synthesized EHR clinical documents to accomplish a set of four pre-formed clinical scenarios using a think-aloud protocol.
  
  
  RESULTS
  Differences in the missing (unretrieved) patient information (2.3±1.2 [with the visualization tool] vs. 6.8±1.2 [without the visualization tool], p = 0.08) and accurate inferences (1.3±0.3 vs 2.3±0.3, p = 0.09) were not statistically significant but suggest some improvement with the new information visualization tool. Despite the non-significant difference in total times to task completion (43±4 mins vs 36±4 mins, p = 0.35) we observed shorter times for two scenarios with the visualization tool, suggesting that the time-saving benefits may be more evident with certain clinical processes. Other observed effects of the tool include more intuitive navigation between patient details and increased efforts towards methodical synthesis of clinical documents.
  
  
  CONCLUSIONS
  Our study provides some evidence that new information visualization in clinical notes may positively influence synthesis of patient information from EHR clinical documents. Our findings provide groundwork towards a more effective display of EHR clinical documents using advanced visualization applications.
authors: O
authors: O
authors: Farri
authors: A
authors: A
authors: Rahman
authors: K A
authors: KA
authors: Monsen
authors: R
authors: R
authors: Zhang
authors: S V
authors: SV
authors: Pakhomov
authors: D S
authors: DS
authors: Pieczkiewicz
authors: S M
authors: SM
authors: Speedie
authors: G B
authors: GB
authors: Melton
mesh_terms: D003626:Data Display; D004282:Documentation; D057286:Electronic Health Records; D063025:Health Information Management / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D013997:Time Factors; D014584:User-Computer Interface
keywords: Electronic health records; data visualization; interfaces and usability
references: Int J Med Inform. 2007 Nov-Dec;76(11-12):801-11
references: 17059892
references: Int J Med Inform. 2010 Dec;79(12):807-16
references: 20961803
references: Health Econ Policy Law. 2006 Apr;1(Pt 2):163-9
references: 18634688
references: Int J Med Inform. 2006 Feb;75(2):163-72
references: 16085454
references: AMIA Annu Symp Proc. 2012;2012:1211-20
references: 23304398
references: Health Aff (Millwood). 2004 Mar-Apr;23(2):116-26
references: 15046136
references: Fam Med. 2005 May;37(5):360-3
references: 15883903
references: J Am Med Inform Assoc. 2010 Jan-Feb;17(1):49-53
references: 20064801
references: J Am Med Inform Assoc. 2004 Jul-Aug;11(4):300-9
references: 15064287
references: J Biomed Inform. 2004 Feb;37(1):56-76
references: 15016386
references: J Am Med Inform Assoc. 2008 Jan-Feb;15(1):54-64
references: 17947628
references: Int J Med Inform. 2007 Feb-Mar;76(2-3):157-68
references: 16854617
references: Inform Prim Care. 2006;14(2):101-8
references: 17059699
references: Proc AMIA Symp. 1998;:29-37
references: 9929179
references: J Am Med Inform Assoc. 2011 Mar-Apr;18(2):112-7
references: 21292706
references: N Engl J Med. 2008 Jul 3;359(1):50-60
references: 18565855
references: AMIA Annu Symp Proc. 2011;2011:1612-20
references: 22195227
references: J Am Med Inform Assoc. 2010 Jan-Feb;17(1):108-11
references: 20064811
references: AMIA Annu Symp Proc. 2003;:269-73
references: 14728176
references: J Biomed Inform. 2005 Apr;38(2):154-71
references: 15797004
references: BMC Med Inform Decis Mak. 2008 Mar 28;8:12
references: 18373858
references: Proc AMIA Symp. 1998;:76-80
references: 9929185
references: AMIA Annu Symp Proc. 2006;:499-503
references: 17238391
references: J Am Med Inform Assoc. 2009 Mar-Apr;16(2):228-37
references: 19074301
references: Int J Med Inform. 2004 Nov;73(11-12):781-95
references: 15491929
references: J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12
references: 14633936
references: J Am Med Inform Assoc. 1998 Nov-Dec;5(6):571-82
references: 9824804
references: Int J Med Inform. 2003 Mar;69(2-3):135-56
references: 12810119
references: Nephrol Dial Transplant. 2009 Sep;24(9):2714-20
references: 19395415
references: Artif Intell Med. 2001 May;22(2):81-8
references: 11348841
references: J Biomed Inform. 2011 Aug;44(4):688-99
references: 21440086
references: J Gen Intern Med. 2009 Jan;24(1):63-8
references: 18998191
references: Crit Care Med. 2011 Jul;39(7):1626-34
references: 21478739
references: Healthc Q. 2005;8 Spec No:99-105
references: 16334081