Objective: Several studies have documented the preference for physicians to attend to the impression and plan section of a clinical document. However, it is not clear how much attention other sections of a document receive. The goal of this study was to identify how physicians distribute their visual attention while reading electronic notes.
Methods: We used an eye-tracking device to assess the visual attention patterns of ten hospitalists as they read three electronic notes. The assessment included time spent reading specific sections of a note as well as rates of reading. This visual analysis was compared with the content of simulated verbal handoffs for each note and debriefing interviews.
Results: Study participants spent the most time in the "Impression and Plan" section of electronic notes and read this section very slowly. Sections such as the "Medication Profile", "Vital Signs" and "Laboratory Results" received less attention and were read very quickly even if they contained more content than the impression and plan. Only 9% of the content of physicians' verbal handoff was found outside of the "Impression and Plan."
Conclusion: Physicians in this study directed very little attention to medication lists, vital signs or laboratory results compared with the impression and plan section of electronic notes. Optimizing the design of electronic notes may include rethinking the amount and format of imported patient data as this data appears to largely be ignored.
Keywords: Electronic health records; attention; documentation; humans; information seeking behavior.