The clinical notes in electronic health records need to be redesigned to match physicians' workflow and information needs, according to a team University of Missouri researchers.
For the study, 16 primary care physicians reviewed progress notes to prepare for patient office visits. They found that the current ambulatory electronic progress notes present more information to the physician than necessary and in antiquated format.
Some parts of the note, such as the review of systems, were ignored. The dominant drivers of note construction were items such as billing, avoiding malpractice and compliance, not information that supported the physicians' information needs for the care of the patients. The researchers recommended that electronic clinic progress notes be "re-engineered" accordingly. Announcement