Table 1.

Summary of studies reviewed in detail (n = 23)

Author	Key theme	Location	Clinical setting (study setting)	Type of note	Sample size	Summary of results
Salmon et al. (2016)35	Purposes	United States	Ambulatory (not specified)	Patient summary	13: Medical directors	Clinical summary purposes: (1) clarify medication regimen; (2) follow-up appointments; (3) patient instructions; (4) referral appointments
Ho et al. (2014)28	Purposes	United States	Ambulatory (not specified)	Visit note	46: PCP, NP	Visit note purposes: (1) clinical; (2) billing and compliance; (3) legal; (4) research; (5) education
Campion et al. (2010)29	Purposes	United States	Hospital (clinical)	Signout note	730: Signout notes	Signout note purposes: communicate patient treatment and care team coordination
Koopman et al. (2015)34	Purposes/ note-retrieval/reading	United States	Ambulatory (simulated)	Visit note	16: PCP	Visit note purposes: clinical, billing, quality improvement, avoid malpractice, and compliance Navigation patterns: A/P is the most important information and the first note section read
Tuepker et al. (2016)27	Purposes/ reasoning	United States	Ambulatory (simulated)	Visit note	38: Mixed	Visit note purposes: to support recall and memory to evaluate and refine patient care Information deemed irrelevant for patient care is frequently left out of the notes
Farri et al. (2013)30	Reasoning	United States	Ambulatory (simulated)	Visit note	8: Interns	Untimed simulations: clinicians focused on (1) time onset of problems, (2) treatment time Timed simulations: clinicians focused on (1) test results, (2) treatment effectiveness Subsequently, clinicians (3) correlated problems and treatment, and (4) reassessed treatment
Farri et al. (2012)36	Reasoning	United States	Ambulatory (simulated)	Visit note	6: Interns	Cognitive pathway to formulate A/P: (1) review chief complaint; (2) review previous diagnoses and history; (3) review previous treatments; (4) correlate past treatment and complaint; (5) create a mental model summarizing the clinical case
Haglin et al. (2017)37	Note-entry	United States	Hospital (simulated)	H&P	8: Interns	Four of 13 (31%) interns observed recorded inaccuracies in their notes Six of 13 (46%) omitted pertinent information collected during the encounter
Wilcox et al. (2010)38	Note-entry	United States	Hospital (mixed)	Progress note	15: MD, residents	ICU physicians tend to avoid templates because their structure conflicts with their mental model Their perception toward templates was positive after evaluating an EHR functionality to tag and search relevant terms for note-entry
Patel et al. (2000)39	Note-entry	Canada	Ambulatory (clinical)	Visit note	7: Endocrinologists	Using an EHR, clinicians documented significantly more chief complaints and significantly less review of systems
Robelia et al. (2017)31	Note-entry	United States	Ambulatory (not specified)	Discharge summary	474: PCP	Discharge summaries frequently include information about list of diagnosis (64%), narrative summary (56%), and treatment provided (42%) Medication list with changes was the most important information for 94% of respondents, only 40% find it in their discharge summaries
Cao et al. (2003)41	Note-entry	United States	Mixed (clinical)	Discharge summary/ signout note/ visit note	383 500: Mixed notes	Less than 1% of the clinical notes reviewed communicate medical errors
Rizvi et al. (2016)40	Note-entry/ note-retrieval/reading	United States	Hospital (clinical)	H&P/ progress note/ discharge summary	12: Residents	Templates are ubiquitously used for note-entry H&P and progress notes are created from the A/P or Subjective sections, and discharge summaries from Hospital course by problem or Discharge diagnosis The sequence of note sections read depends on stimulus or task to perform
Nolan et al. (2017)32	Note-retrieval/reading	United States	Hospital (clinical)	Mixed	24: MD, NP	Chart review time is spent on clinical notes (47%), followed by labs (22%), and imaging (13%). The most common navigation pattern started with clinical notes, followed by imaging and labs
Pain et al. (2017)33	Note-retrieval/reading	Australia	Hospital (not specified)	Mixed	53: Mixed	Stimuli to read allied health professional notes: patient care, patient function, discharge planning, and a holistic approach to patient care SOAP was the most common note-retrieval format
Kendall et al. (2013)42	Note-retrieval/reading	United States	Hospital (simulated)	Signout note	21: MD, residents	Clinicians spent 52% of their review time in narrative data sources and 40% in structured data sources Navigation patterns vary widely even within cases Structured data are more frequently read after receiving new information about the case
Staggers et al. (2011)43	Note-retrieval/reading	United States	Hospital (clinical)	Patient summary	26: RN	Electronic patient summary does not meet nurses’ information needs Effective patient summaries to support nursing care must include medical history
Callen et al. (2014)44	Note-retrieval/reading	Australia	Hospital (clinical)	Discharge summary/ visit note	97: MD, RN	Nurses and physicians tend to read patient medical history to advance common orders Past history is more likely to be read for urgent cases
Wright et al. (2016)45	Note-retrieval/reading	United States	Hospital (clinical)	Mixed	20: MD, NP, RN	Stimuli to read clinical notes include (1) new patient assessment; (2) reviewing the status of a known patient; (3) search for specific information, and (4) prioritize multiple patients
Hilligoss and Zheng (2013)46	Note-retrieval/reading	United States	Hospital (clinical)	Mixed	73: MD, surgeons	Stimuli to read clinical notes: (1) patient overview; (2) handoff/subsequent care; (3) avoid biases (ie the tendency to consider a diagnosis suggested by the previous provider)
Brown et al. (2014)47	Note-retrieval/reading	United States	Hospital (simulated)	Progress note	10: Hospitalists	Sixty-seven percent of the reading time was dedicated to A/P, followed by labs (8%), and medications (7%) Time reading a note section has very little to do with the volume of data in that section
Clarke et al. (2014)48	Note-retrieval/reading	United States	Ambulatory (simulated)	Visit note	15: PCP	History of present illness and A/P are the most important and most read sections of a visit note Review of Systems is the least read section
Horsky and Ramelson (2016)49	Note-retrieval/reading	United States	Ambulatory (simulated)	Patient summary	9: PCP	Clinicians review patient summaries in three stages: (1) look for historical data and read A/P; (2) look for changes since last visit; and (3) look for data about current state (eg, vitals, labs)

Abbreviations: PCP: primary care provider; NP: nurse practitioner; MD: practicing/attending physician; H&P: history and physical note; EHR: electronic health records; ICU: intensive care unit; RN: registered nurse; TA: think-aloud protocol; A/P: assessment and plan.