4 ways to eliminate 'chartjunk,' improve decision support from EHRs

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A common complaint about EHRs is that they are tedious to work with and provide extraneous information at the point of care.

"Redundant items such as laboratory results and copy-and-pasted nursing flow sheet data introduce a variety of 'chartjunk' that clutters documentation nod makes the identification of truly important information more difficult and potentially even introduces errors that are then propagated throughout the chart," according to a paper in JMIR Medical Informatics.

The authors of the paper outlined ways to help eliminate such "chartjunk" and optimize the note creation process to best facilitate communication and care coordination.

1. According to the authors, an ideal, optimized EHR would provide useful predictive data analytics and map a projected clinical trajectory. The EHR userface would then be designed in such a way that the important elements are still presented and available but in such a way that does not overwhelm the user. The authors described this as "maximally informationally rich and minimally distracting graphic display," and wrote there is still room for innovation and improvement in this area.

2. Bedside and telemetry monitors should bidirectionally interact with the EHR to provide decision support, according to the authors. Such monitors can provide data analytics for real-time assessment, and the EHR can provide context for interpreting raw data and vital signs.

3. The authors also suggested formulating notes in real-time, which would likely require natural language processing at the point of care while free text is being entered into the EHR. They also highlight the importance of free text in medical care. "Free text inserts a needed narrative element into the otherwise storyless EHR environment," they wrote. "Medical care can be described as an ongoing story, and free text conveys this story in a much more effective and interesting fashion than do selected structured data bits."

4. An optimized system would then use all the data coming from different inputs and help formulate a care plan. "The vast amount of information and clinical choices demands that we provide better supports for making decisions and effectively documenting them," the authors wrote.

More articles on EHRs:

Jumping ship: Why hospitals switch EHR vendors & how to handle the aftermath
Cerner President Zane Burke: Why clients are switching EHRs from 'our primary competitor'
HHS' OIG to review efficacy of FDA's oversight of medical devices linked to EHR

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