title: Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note.
abstract: BACKGROUND
  Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes.
  
  
  METHODS
  This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers.
  
  
  RESULTS
  The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter.
  
  
  CONCLUSIONS
  Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia. koopmanr@health.missouri.edu.
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Koopman
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Linsey M Barker
authors.initials: LM
authors.lastname: Steege
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Joi L
authors.initials: JL
authors.lastname: Moore
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Martina A
authors.initials: MA
authors.lastname: Clarke
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Canfield
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Min S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: From the Department of Family and Community Medicine (RJK, JLB), the Department of Health Management and Informatics (MAC, MSK), and the Center for Health Policy (SMC), University of Missouri School of Medicine, Columbia; the School of Nursing (LMBS) and the Center for Quality and Productivity Improvement (LMBS), University of Wisconsin, Madison; the School of Information Science and Learning Technologies, College of Education (JLM), and the Informatics Institute (JLM, MAC, MSK), University of Missouri, Columbia.
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Belden
mesh_terms: D001291:Attitude of Health Personnel; D003071:Cognition; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D058007:Physicians, Primary Care / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D036301:Qualitative Research; D058996:Quality Improvement; D057188:Workflow
keywords: Decision Theory; Electronic Health Records; Information Systems; Medical Informatics; Qualitative Research