Poster (Times are in PDT)

Board 23 - Note It Right: Utilizing EMR Tools to Reduce Note Bloat in Inpatient Progress Note Templates

3:30 PM–4:30 PM May 20, 2020 (Conference Time: US - Pacific)

3:30 PM–4:30 PM May 20, 2020


Abstract: Background: Despite the numerous benefits of electronic health records, they have propagated lengthy and redundant notes. At our tertiary care pediatric hospital with a high degree of trainee turnover we identified high variability in documentation in our pediatric hospital medicine (PHM) progress notes with significant note bloat. We aimed to standardize and shorten the length of progress notes utilized by physicians by increasing progress note template utilization to 80% and decreasing note length by 10% within 12 months.
Methods: We created an interdisciplinary team (physicians, medical informaticists, a clinical documentation specialist, billing specialist, and Chief Medical Informatics Officer). After needs assessment and with key stakeholder input, we utilized disappearing help text, selective copy/paste, note hyperlinks, and reduction of auto-pull data to create a new progress note template.
Results: Post intervention, note length decreased by an average of 860 characters per note (8679 to 7819), a 10% reduction. The average number of coding queries decreased from 50 to 38 queries on average per month as a balancing measure. This reduction occurred despite an overall per patient increase in the number of hospital problems, LOS, and DRGs, indicating increased patient complexity over time. Note template utilization increased from a baseline average of 68% to 83%.
Conclusion: Our interdisciplinary team successfully increased progress note template utilization and decreased note length without an increase in coding queries. Buy-in and input from key stakeholders, increased note usability, and embedded disappearing help text within note templates were important features in our success.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: Attendees will learn best practices for note template creation and ideas on how to utilize EHR-based tools to facilitate note bloat reduction (disappearing help text, selective copy/paste, note hyperlinks).


Amy Chong (Presenter)
University of California San Diego

Begem Lee, University of California San Diego
Elizabeth Mannino Avila, University of California San Diego
Melissa Cameron, University of California San Diego
Cynthia Kuelbs, University of California San Diego