Determining primary care physician information needs to inform ambulatory visit note display

Area of Science:

• Medical Informatics
• Clinical Documentation
• Human-Computer Interaction

Background:

• Increasing adoption of Electronic Health Records (EHR) in the US leads to information overload for primary care physicians (PCPs).
• Effective EHR display design is crucial for managing the volume of clinical information presented to physicians.
• Understanding physician information needs is key to optimizing EHR usability.

Purpose of the Study:

• To determine the essential information needs of PCPs during the review of clinic visit notes.
• To inform the design and display of EHR systems to reduce physician cognitive load.
• To identify which sections of clinical notes are most relevant to primary care practice.

Main Methods:

• Pilot study involving 15 primary care physicians.
• Semi-structured interviews with a third-party observer to ensure unbiased data collection.
• Physicians reviewed artificial acute and chronic care visit notes to identify relevant sections using statistical analysis (McNemar-Mosteller's, Cochran Q).

Main Results:

• History of Present Illness (HPI) and Assessment and Plan (A&P) were identified as the most critical note sections.
• Review of Systems (ROS) was largely considered superfluous by physicians.
• Statistically significant differences were observed in physicians' highlighting of all seven major note sections for both acute and chronic care notes (p = 0.00).

Conclusions:

• PCPs prioritize HPI and A&P sections, suggesting a need to streamline lengthy notes.
• While often deemed unnecessary, ROS can contain critical patient data when other sections are incomplete.
• Future research should focus on EHR display optimization, prioritizing key information and potentially repositioning A&P sections for improved physician efficiency and reduced cognitive load.