Table 4.

Key findings and implications for future research

Key theme	Finding	Suggestion for future research
Note purposes	Clinical care is the primary purpose for creating clinical notes in both ambulatory and hospital settings28,29 Non-clinical purposes are common and a source of frustration34	Investigate the impact of billing and other administrative requirements on note-entry and develop solutions to alleviate the documentation burden Investigate how billing and other compliance requirements (eg quality improvement, accreditation) contribute to non-clinical note purposes
Clinicians’ reasoning	Clinicians tend to judge the clinical relevance of information they communicate in their clinical notes27 Clinicians’ thought process for note-retrieval/reading can be represented in cognitive pathways36 Cognitive pathways are affected by time restrictions30	Investigate what information clinicians find relevant to communicate (or not) and why Investigate how EHRs could capture and represent what clinicians are thinking about the patients and their problems, and the impact of such a representation on clinicians’ situational awareness
Note-entry strategies	The use of templates varies within and between physicians and across specialties38,40 What clinicians communicate can be affected by the data entry structure of EHR systems39 Discharge summaries frequently miss information considered to be relevant for follow-up care31	Investigate how EHRs can seamlessly support note-entry without forcing specific content to be added or removed Investigate information needs of clinicians and develop solutions to capture data needed to create more informative notes
Note-retrieval/reading strategies	What content and in what order clinicians read are factors influenced by external stimuli, care goals, and what they already know about the patient33,40,45 A/P is the first and most read section of both ambulatory and hospital notes34,47,48	Investigate how EHRs can seamlessly support note-retrieval/reading with stimulus- or goal-based user interfaces that allow a holistic view of the patient and flexible navigation across different parts of the record

Abbreviations: EHR: electronic health records; A/P: assessment and plan.