Table 3.

Recommendations for EHR design from studies included in the sub-analysis (n = 9)

Author	Study design	Location	Clinical Setting	Type of note/process	Sample size	Summary of recommendations
Bansler et al. (2016)2	Descriptive study	Denmark	Mixed	Mixed paper-based notes	Not specified	Authors recommend designing EHRs that can keep the richer narrative format of clinical notes and develop solutions to convert narrative data into structured data for secondary uses.
Miles 200650	Descriptive study	United States	Nursing home	Paper-based progress note	Not specified	Authors used visual symbols to document clinicians’ reasoning in paper-based progress notes, similar symbols can be used for representing clinicians’ reasoning in EHRs.
Mukhopadhyay et al. (2014)51	Qualitative study	Singapore	Hospital	Handoff (process)	580:MD, RN	For donor (ie the provider handing a patient over) nurses signout notes must inform the complexity of the cases and for donor residents overall management plans. On the recipient side, signout notes must inform past medical history including allergies for nurses, and management plan over the next 48 hours for residents.
Halloran and Halloran (2015)52	Descriptive study	United States	Mixed	Patient summary	Not specified	Provides a checklist of data needed to create nursing patient summaries based on the International Counsel of Nursing - Basic Principles of Nursing Care.
Denny et al. (2009)53	Randomized case-control study	United States	Mixed	H&P	319:H&P notes	The study is an evaluation of an algorithm (SecTag) to identify note section headers. The algorithm identified non-labeled content in several H&P notes. Most common unlabeled sections include substance abuse history, vital signs, labs and radiology, and family history. Future EHRs must provide better solutions to inform note section headers.
Hebal et al. (2017)54	Case-control study	United States	Ambulatory	Visit note	149:Mixed notes	Authors developed and evaluated a visit note template in a bowel clinic and demonstrated that the use of a template significantly increases documentation and retrieval of relevant information.
Mistry et al. (2010)55	Descriptive study	Canada	Hospital	Signout note	49:MD	Based on data gathered from a survey notes review, authors provide a minimum data set for handoffs to inform design of electronic signout notes.
Flemming et al. (2015)56	Descriptive study	Germany	Hospital	Handoff (process)	28:RN	Based on cognitive psychology and HCI principles authors developed a cognitive framework to support information transfer during handoffs. They recommend the use of visual shapes (eg, squares, hexagons) and colors to represent information relevant to communicate.
Belden et al. (2017)57	Descriptive study	United States	Ambulatory	Progress note		Based on usability testing of clinical note prototypes and semi-structured interviews, researchers found that the APSO format coupled with collapsible note sections as more acceptable and efficient for physicians.

Abbreviations: MD: practicing/attending physician; H&P: history and physical note; EHR: electronic health records; RN: registered nurse; HCI: human-computer interaction; APSO: Assessment, plan, subjective, objective.