Electronic Health Record (EHR) systems improve patient care by reducing redundancy in prescribing and computerized ordering but paradoxically also generate other types of information redundancy that lead to information overload. This presents a challenge for clinicians in providing safe and effective care especially with complex patients requiring synthesis of many clinical elements across a lengthy medical history. We hypothesize that provider usage of clinical notes can be supported through refinement of automated methods to detect new information, facilitation of new information visualization in practice, and EHR clinical note interface optimization. While there is much interest in supporting evidence-based medicine, little attention has been given to assisting clinicians in navigating and synthesizing growing amounts of electronic data for individual patients. Unstructured narrative text is an important part of modern EHRs. Text allows clinicians to communicate complex and nuanced information in a manner that is easily comprehended by others. While analyzing a collection of patient's notes can be formidable, it is necessary for making diagnostic and therapeutic decisions. Currently, this process is hindered by many factors, including large amounts of redundant information in these texts, increasing numbers of documents, suboptimal user interface (UI) design, and limited time to interact with patients. There is a critical need to optimize the use of EHR clinical notes for providers, which we propose to address in three aims: 1) Refine computational methods to identify new information in clinical notes, 2) Assess the effect of visualizing new information in clinical notes in an inpatient hospitalist setting, and 3) Discover elements of a rationally designed EHR graphical UI to facilitate clinical document usage in practice. Successful accomplishment of these aims will lay a foundation to make clinicians more efficient, improve decision-making, decrease cognitive load, and potentially increase clinician satisfaction associated with using clinical documents in EHR systems.

Public Health Relevance

The ability to improve the use of clinical documents in electronic health record systems using automated new information identification methodologies, text visualization tools, and user interface design will assist clinicians in better accessing patint information and effectively using health information technology. This knowledge could ultimately contribute to improved patient care through better clinical decision-making with information from patient notes.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
4R01HS022085-03
Application #
8930998
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Kim, Bryan
Project Start
2013-09-30
Project End
2017-09-29
Budget Start
2015-09-30
Budget End
2016-09-29
Support Year
3
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Minnesota Twin Cities
Department
Type
Organized Research Units
DUNS #
555917996
City
Minneapolis
State
MN
Country
United States
Zip Code
55455
Gupta, Ashwin; Harrod, Molly; Quinn, Martha et al. (2018) Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors. Diagnosis (Berl) 5:151-156
Rizvi, Rubina F; Adam, Terrence J; Lindemann, Elizabeth A et al. (2018) Comparing Existing Resources to Represent Dietary Supplements. AMIA Jt Summits Transl Sci Proc 2017:207-216
Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei et al. (2018) Usability Evaluation of an Unstructured Clinical Document Query Tool for Researchers. AMIA Jt Summits Transl Sci Proc 2017:84-93
Sun, Deyu; Simon, Gyorgy J; Skube, Steven et al. (2017) Causal Phenotyping for Susceptibility to Cardiotoxicity from Antineoplastic Breast Cancer Medications. AMIA Annu Symp Proc 2017:1655-1664
Sun, Deyu; Sarda, Gopal; Skube, Steven J et al. (2017) Phenotyping and Visualizing Infusion-Related Reactions for Breast Cancer Patients. Stud Health Technol Inform 245:599-603
Fan, Yadan; Adam, Terrence J; McEwan, Reed et al. (2017) Detecting Signals of Interactions Between Warfarin and Dietary Supplements in Electronic Health Records. Stud Health Technol Inform 245:370-374
Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei et al. (2017) Usability Evaluation of NLP-PIER: A Clinical Document Search Engine for Researchers. Stud Health Technol Inform 245:1269
Rizvi, Rubina F; Marquard, Jenna L; Hultman, Gretchen M et al. (2017) Usability Evaluation of Electronic Health Record System around Clinical Notes Usage-An Ethnographic Study. Appl Clin Inform 8:1095-1105
Fan, Yadan; He, Lu; Pakhomov, Serguei V S et al. (2017) Classifying Supplement Use Status in Clinical Notes. AMIA Jt Summits Transl Sci Proc 2017:493-501
McEwan, Reed; Melton, Genevieve B; Knoll, Benjamin C et al. (2016) NLP-PIER: A Scalable Natural Language Processing, Indexing, and Searching Architecture for Clinical Notes. AMIA Jt Summits Transl Sci Proc 2016:150-9

Showing the most recent 10 out of 24 publications