EHR Redesign Necessary for Efficient Care Delivery in Primary Care Clinics

Researchers at the University of Missouri are of the opinion that modifying the existing version of electronic health records (EHRs) to better match physician needs can significantly improve patient care.

Since 2009, when the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law to promote adoption and meaningful use of health information technology, nearly 80% of office-based physicians have adopted EHRs. But studies have shown that physicians are not quite satisfied with EHRs. A survey conducted by the American College of Physicians found that user satisfaction was down by more than 12% from 2010 to 2012 and the “very dissatisfied” increased by 10% during that period.

“While EHRs have granted physicians access to more information than ever before, they also include lots of extraneous information that does not contribute to the care of the patient,” said Richelle Koopman, MD, associate professor of family and community medicine at the MU School of Medicine.

In the current study, the results of which are published in the Journal of the American Board of Family Medicine, Koopman and colleagues examined physician information needs to prepare for clinic visits, with the hope of overcoming unnecessary daily cognitive overload. Using cognitive task analysis, 16 primary care physicians (PCPs) were asked to review simulated acute and chronic care visit notes, in preparation for office visits. Field notes were gathered and cognitive interviews were audio recorded. Findings from the subsequent analysis were presented to participating physicians and their peers.

The study found that PCPs paid most attention to the Assessment and Plan section and were frustrated with the Review of Systems section. They also pointed out clutter created by information repeated in different parts of the chart, including a workflow with a patient summary dashboard.

Koopman believes these results shout out the need for changing the information needed for medical billing and point to a more streamlined way of presenting medical information to reduce medical errors that compromise patient safety. Future research efforts include a collaborative study that will evaluate an eye-tracking software to determine the ideal clinical notes prototype.