The Process by which Physicians Extract Information from Electronic Progress Notes During Handoffs

Criteria Decision Making and Stochastic Processes, my friends and colleagues, Ze He for his helpful comments and support, Junghee Jo for creating the visualization tool used in this thesis and Jennifer Badylak-Reals for helping me code the raw data for the thesis. Special thanks go out to my parents for their moral and financial support and for their continued belief in me, and to Ben and Larissa, who have helped me whenever I needed them, and for making it possible for me to do the undoable. A handoff requires that the responsibility for patient patient's care is transferred from one healthcare professional to another. The goals of this research were to identify, evaluate, and use analytical methods to describe how physicians (n=10) extracted information from electronic progress notes, one important source of information used during handoffs. Participants also verbally summarized the notes as they would during handoffs. Six methods were used to analyze how participants read progress notes, each uniquely contributing to our understanding of physicians' visual attention patterns during this process. The participants focused their visual attention on the Impression and Plan section of the progress notes in that over 60% of the participants' total time was spent reading that section. Physicians could miss an error or critical piece of information if the information is not located in the Impression and Plan. The importance given by the participants to the Impression and Plan section was confirmed in that the majority of participants' verbal handoff content focused primarily on information that could be found in the Impression and Plan. Participants relied on the Medication Profile section quite heavily if it was present in the progress note. vi We determined that if the participant was currently reading in one section (s)he most likely would transition his/her visual attention to the physically closest section in the note, meaning the format of progress notes may dictate how notes are read. We determined what the most likely paths were through the progress notes, which could be a first step in reordering of the progress note for evaluation in future studies. Participants' responses to debriefing questions suggested that they were aware of their reliance on the Impression and Plan, but that they thought the way they read notes is context-specific, depending on factors such as their use of the note and the reputation of the author of the note. These findings suggest a need for …