Call Me Dr Ishmael: Trends in Electronic Health Record Notes Available at Emergency Department Visits and Admissions

Objectives Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment.Materials and Methods We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of notes and a corresponding number of total words and total tokens across all notes available to physicians during patient encounters in the emergency department (ED). We assessed the change in these metrics over a 17-year period between 2006 and 2023.Results The study cohort included 730 968 ED visits made by 293 559 unique patients and a total note count of 132 574 964. The median note count for all encounters in 2006 was 5 (IQR 1-16), accounting for 1735 (IQR 447-5521) words. By the last full year of the study period, 2022, the median number of notes had grown to 359 (IQR 84-943), representing 359 (IQR 84-943) words. Note and word counts were higher for admitted patients.Discussion The volume of notes available for review by providers has increased by over 30-fold in the 17 years since the implementation of the EHR at a large health system. The task of reviewing these notes has become commensurately more difficult. These data point to the critical need for new strategies and tools for filtering, synthesizing, and summarizing information to achieve the promise of the medical record. This study examines the increasing volume of electronic health record (EHR) notes that healthcare providers must review, particularly in emergency departments (EDs). Since the early 2000s, the adoption of EHRs in US hospitals has allowed for better access to patients' previously stored notes, which are reviewed by ED providers treating new patients. However, the sheer volume of information, growing with each patient visit, challenges providers to quickly and effectively digest this critical data during acute care episodes. We analyzed EHR data from 2 EDs, focusing on the number of notes, words, and text tokens available to providers per patient encounter over time. We found a significant increase in these metrics over time, complicating the "chart biopsy" process where providers skim patient histories to inform care decisions. While centralizing data storage is a key function of EHR's, their usefulness may be diminished by information overload. The growing volume of text data contained in EHRs calls for advanced solutions to manage information overload effectively, including possibly using large language models to summarize lengthy patient charts.