title: Internal medicine progress note writing attitudes and practices in an electronic health record.
abstract: BACKGROUND
  The electronic health record (EHR) has been viewed with both praise and skepticism. Multiple editorials have expressed concerns that EHR implementation and "efficiency tools" such as copy forward and auto population have resulted in a decrement in note accuracy, relevance, and critical thinking.
  
  
  OBJECTIVE
  To evaluate the perceptions of internal medicine housestaff and attendings on inpatient progress note quality at 4 academic institutions after the implementation of an EHR.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  We developed surveys that assessed housestaff and attendings opinion of current progress note quality, the impact of the EHR on quality, and the purposes of a progress note.
  
  
  RESULTS
  We received 99 completed surveys from interns (66%), 155 from residents (49%), and 153 from attendings (70%) across 4 institutions. The majority of housestaff responded that the quality of notes was "unchanged" or "better" following the implementation of an EHR, whereas attendings believed note quality was "unchanged" or "worse." Attendings' perceptions of housestaff notes were significantly lower than housestaff perceptions of their own notes across all domains. With regard to the effect of copy forward and autopopulation, the majority of housestaff viewed these to be "neutral" or "somewhat positive," whereas attendings viewed these as "neutral" or "somewhat negative." Housestaff and attendings had nearly perfect agreement regarding the purpose of the progress note.
  
  
  CONCLUSIONS
  Attendings and housestaff disagree on the current quality of progress notes and the impact of an EHR on note quality, but agree on the purpose of a progress note.
authors.affiliation: Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California.|Department of Medicine, Division of Hospital Medicine, Alameda Health System, Oakland, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stewart
authors.affiliation: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kahn
authors.affiliation: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Wendy
authors.initials: W
authors.lastname: Simon
authors.affiliation: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Duncan
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Hilary
authors.initials: H
authors.lastname: Mosher
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Katherine
authors.initials: K
authors.lastname: Harris
authors.affiliation: Department of Internal Medicine, Division of Hospital Medicine, University of California, San Diego, San Diego, California.
authors.forename: John
authors.initials: J
authors.lastname: Bell
authors.affiliation: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
authors.forename: Neveen
authors.initials: N
authors.lastname: El-Farra
authors.affiliation: Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Bradley
authors.initials: B
authors.lastname: Sharpe
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies / Q000379:methods; D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000379:methods* / Q000592:standards; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008505:Medical Staff, Hospital / Q000592:standards