What do physicians read (and ignore) in electronic progress notes?

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Clinical Documentation

Background:

• Physician attention is crucial for effective clinical decision-making.
• Previous research indicates a preference for the "Impression and Plan" section of clinical notes.
• Limited understanding exists regarding physician visual attention distribution across other electronic note sections.

Purpose of the Study:

• To investigate how physicians distribute their visual attention while reading electronic health records.
• To quantify the time and reading speed allocated to different sections of electronic notes.

Main Methods:

• Utilized eye-tracking technology to monitor the visual attention of ten hospitalists.
• Assessed reading time and rates across specific sections of three electronic notes.
• Correlated visual analysis with simulated verbal handoffs and debriefing interviews.

Main Results:

• Physicians spent the most time and read slowest in the "Impression and Plan" section.
• Sections like "Medication Profile," "Vital Signs," and "Laboratory Results" received less attention and were read quickly.
• Only 9% of physician verbal handoffs included information outside the "Impression and Plan" section.

Conclusions:

• Physicians exhibit a strong focus on the "Impression and Plan" section, largely overlooking medication lists, vital signs, and lab results.
• Electronic note design may require optimization, particularly regarding the presentation and format of imported patient data.
• Current electronic health record designs may lead to critical patient data being ignored.