American Association for Pediatric Ophthalmology and Strabismus
American Association for Pediatric Ophthalmology and Strabismus
April 01, 2019
2 min read

EHR documentation reflects ‘paper note paradigm’

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Michael F. Chiang

SAN DIEGO — Very little content in electronic health record notes is manually entered, the notes are long and redundant, and most are not even looked at, Michael F. Chiang, MD, said at the American Association for Pediatric Ophthalmology and Strabismus annual meeting.

To demonstrate how much EHR text is manually entered rather than copied from templates and previous chart notes, Chiang and colleagues looked at 2 years of EHR notes of six pediatric ophthalmologists and found that 74% of notes regarding 2,893 new visits was imported from outside sources and 89% of notes regarding 11,978 return visits was imported.

“The question is, how much unique thought is really going into these notes?” he asked.

When looking at redundancy between notes from serial visits of the same patient with the same diagnosis seeing the same provider, Chiang and colleagues found the average length of the notes was about 6.5 pages each, with only about 32% being new content.

To determine how much of the notes are being read by the attending physicians, Chiang and colleagues looked at audit logs for the most recent follow-up office visit per patient to determine how many prior notes were reviewed. Over a 3-year period for three pediatric ophthalmologists, the researchers found the mean number of prior notes read by the attending physician was two, only 7% of notes in the record.

Even though EHRs have “clearly revolutionized” the practice of ophthalmology, the redundant and voluminous notes are based on “old paper note paradigms” that lend themselves more to billing and compliance than to clinical documentation. “We’re using paper methods in an electronic world,” Chiang said.

“What this presents are opportunities to develop new paradigms of documentation that improve quality of care and efficiency of care and provide infrastructure for reporting and aggregating data for so-called big data analytics. That’s going to require a combination of things: No. 1 technology, No. 2 clinical insight and No. 3 policy making,” he said. – by Patricia Nale, ELS


Chiang MF. Ophthalmology documentation in EHRs: where does it come from and who’s looking? Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; March 28 to 31, 2019; San Diego.

Disclosure: Chiang reports he is a consultant for Clarity Medical Systems and Novartis, is an equity owner in Inteleretina, and receives grant support from the National Institutes of Health, Genentech and the National Science Foundation.