TY - JOUR
T1 - Correctly structured problem lists lead to better and faster clinical decision-making in electronic health records compared to non-curated problem lists
T2 - A single-blinded crossover randomized controlled trial
AU - Klappe, Eva S.
AU - Heijmans, Jarom
AU - Groen, Kaz
AU - ter Schure, Judith
AU - Cornet, Ronald
AU - de Keizer, Nicolette F.
N1 - Funding Information: This study was supported by Amsterdam UMC (UMC 2019-AMC-JK-7). The funder had no role in the design and conduct of the study; collection, management analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2023 The Author(s)
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: Correctly structured problem lists in electronic health records (EHRs) offer major benefits to patient care. Without structured lists, diagnosis information is often scatteredly documented in free text, which may contribute to errors and inefficient information retrieval. This study aims to assess whether EHRs with correctly structured problem lists result in better and faster clinical decision-making compared to non-curated problem lists. Methods: Two versions of two patient records (A and B) were created in an EHR training environment: one version included diagnosis information structured and coded on the problem list (“correctly structured problem list”), the other version had missing problem list diagnoses and diagnosis information partly documented in free text (“non-curated problem list”). In this single-blinded crossover randomized controlled trial, healthcare providers, who can prescribe medications, from two Dutch university medical center locations first evaluated a randomized version of patient A, then B. Participants were asked to motivate their answer to two medication prescription questions. One (test) question required information similarly presented in both record versions. The second (comparison) question required information documented on problem lists and/or in notes. The primary outcome measure was the correctness of the motivated answer to the comparison question. Secondary outcome measure was the time to answer and motivate both questions correctly. Results: As planned, 160 participants enrolled. Two were excluded for not meeting inclusion criteria. Correctly structured problem lists increased providers’ ability to answer the comparison question correctly (56.3 % versus 33.5 %, McNemar odds ratio 2.80 (1.65–4.93) 95 %-CI). Median time to answer both questions correctly was significantly lower for EHRs with correctly structured problem lists (Wilcoxon-signed-rank test p = 0.00002, with incorrect answers coded equally at slowest time). Conclusions: Correctly structured problem lists lead to better and faster clinical decision-making. Increased structured problem lists usage may be warranted for which implementation policies should be developed.
AB - Background: Correctly structured problem lists in electronic health records (EHRs) offer major benefits to patient care. Without structured lists, diagnosis information is often scatteredly documented in free text, which may contribute to errors and inefficient information retrieval. This study aims to assess whether EHRs with correctly structured problem lists result in better and faster clinical decision-making compared to non-curated problem lists. Methods: Two versions of two patient records (A and B) were created in an EHR training environment: one version included diagnosis information structured and coded on the problem list (“correctly structured problem list”), the other version had missing problem list diagnoses and diagnosis information partly documented in free text (“non-curated problem list”). In this single-blinded crossover randomized controlled trial, healthcare providers, who can prescribe medications, from two Dutch university medical center locations first evaluated a randomized version of patient A, then B. Participants were asked to motivate their answer to two medication prescription questions. One (test) question required information similarly presented in both record versions. The second (comparison) question required information documented on problem lists and/or in notes. The primary outcome measure was the correctness of the motivated answer to the comparison question. Secondary outcome measure was the time to answer and motivate both questions correctly. Results: As planned, 160 participants enrolled. Two were excluded for not meeting inclusion criteria. Correctly structured problem lists increased providers’ ability to answer the comparison question correctly (56.3 % versus 33.5 %, McNemar odds ratio 2.80 (1.65–4.93) 95 %-CI). Median time to answer both questions correctly was significantly lower for EHRs with correctly structured problem lists (Wilcoxon-signed-rank test p = 0.00002, with incorrect answers coded equally at slowest time). Conclusions: Correctly structured problem lists lead to better and faster clinical decision-making. Increased structured problem lists usage may be warranted for which implementation policies should be developed.
KW - Clinical decision making
KW - Electronic health records
KW - Problem list
KW - Problem-oriented medical records
KW - Structured and standardized data capture
UR - http://www.scopus.com/inward/record.url?scp=85175444828&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijmedinf.2023.105264
DO - https://doi.org/10.1016/j.ijmedinf.2023.105264
M3 - Article
C2 - 37890203
SN - 1386-5056
VL - 180
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
M1 - 105264
ER -