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

Objective: 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 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 7 (IQR: 3 - 18), accounting for 1,894 words (IQR: 538 - 5,864). By the last full year of the study period in 2022, the median number of notes had grown to 380 (IQR: 93 - 1,008), representing 61,591 words (IQR: 13,621 - 174,152). Note and word counts were higher for admitted patients. Conclusion: 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 correspondingly 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The University of Wisconsin Minimal Risk Review IRB conducted a review of this study. The study was determined to meet the criteria for exempt human subjects in accordance with the following category(ies) as defined under 45 CFR 46: (4) Secondary research on data or specimens (no consent required) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors, within institutional and legal constraints surrounding sharing of PHI.