Dynamic Electronic Health Record Note Prototype: Seeing More by Showing Less.

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Clinical Documentation

Background:

• Cluttered electronic health records (EHRs) can increase physician cognitive load.
• High-value clinical information may be obscured by less relevant data.
• Novel documentation designs are needed to improve information retrieval.

Purpose of the Study:

• To test a novel, collapsible Assessment, Plan, Subjective, Objective (APSO) note design.
• To compare the APSO note's usability against the traditional Subjective, Objective, Assessment, Plan (SOAP) note.
• To evaluate speed, accuracy, and user satisfaction for chronic disease care information retrieval.

Main Methods:

• Iterative development of physician clinic note prototypes with enhanced information display.
• Sixteen primary care physicians performed timed information retrieval tasks using four note styles (SOAP, 2-column APSO, collapsible APSO, 2-column collapsible APSO).
• Evaluated performance via time on task, task success (accuracy), NASA Task Load Index, usability ratings, and post-task interviews.

Main Results:

• Collapsible APSO note styles (C and D) were significantly faster for specific tasks.
• Note styles B (2-column APSO) and C (collapsible APSO) demonstrated the highest success rates.
• Physicians favored the new APSO note features, with usability ratings higher for APSO compared to SOAP.

Conclusions:

• The APSO note prototypes outperformed the traditional SOAP format in speed, accuracy, and usability.
• Innovative EHR documentation displays, like collapsible sections, can improve information access without data loss.
• Moving Assessment and Plan sections to the top is a practical enhancement for clinical workflows.