Wading through words: Finding the right health information at the right time

Jan. 30, 2023 / By Travis Bias, DO, MPH, FAAFP

How do physicians find the information they need to make decisions in the electronic health record (EHR)? How does the EHR organize information – narrative and more discrete data elements – to support the way clinical teams naturally work? 

First, let’s set the scene: A recent study published in Journal of the American Medical Association (JAMA) revealed that half of all documentation in the electronic health record (EHR) at a large quaternary care center over a six-year period was duplicated, or rather copied and pasted forward from a prior clinical note. This amounted to 16 billion – with a “b” – words of 32 billion words analyzed. For reference, the authors note that the entire English language Wikipedia contains about 4 billion words. 

Is copy and paste in clinical documentation necessarily a bad thing, though?  

On top of potential information overload, the study also raised the concern of information scatter. The authors found that the median “patient record has one-sixth of the word count of William Shakespeare’s longest written work, ‘Hamlet.’” So, “a physician seeing 12 patients in a day would be responsible for reviewing at least 85 pages of single-spaced text,” or 2 copies of Hamlet each day! With obvious time and attention limitations, it’s essentially impossible for a human clinician to absorb, synthesize and act on all of that information. This can impede clinical teams’ ability to provide complete and efficient care.  

Fortunately, I hosted one of the study’s co-authors on the latest 3M Inside Angle podcast episode. Dr. Subha Airan-Javia is the former associate chief medical information officer for the University of Pennsylvania Health System. She is currently a hospitalist for the Hospital of the University of Pennsylvania and CEO and co-founder of CareAlign, a dynamic, collaborative care planning tool with a mobile view of real time EHR data. 

We covered documentation myths that can lead to over-documenting, for both reimbursement and defensive reasons. We discussed the spark that gave rise to CareAlign. And we uncovered our shared fascination with the nephron. 

Thanks for listening! 

Dr. Travis Bias is a family medicine physician and chief medical officer of clinician solutions at 3M Health Information Systems.