MADISON, Wis. — A study from the University of Wisconsin School of Medicine and Public Health has found that the size of medical notes, also known as chart biopsies, has increased dramatically over the past 17 years, making it increasingly difficult for doctors to sift through the flood of information during emergency room visits.
The study with the funny title Call me Dr. Ishmael – a reference to Herman Melville’s Moby Dick and the length of file biopsies – shows that in two UW Health emergency departments, one in five patients brings in a file containing more than 206,000 words.
This is not a new puzzle, and about 4 percent of patients have medical records that are twice as long, at about 560,000 words – almost as long as Leo Tolstoy’s War and peace.
Doctors typically skim a biopsy to get the necessary information about the patient’s medical history to help them make a diagnosis. This often happens within a few minutes. With all this extra information, it can be difficult to figure out what’s important.
“Unfortunately, we have become victims of our own success and in many cases we have gone from a situation where we don’t know enough about a patient to a situation where we have an overwhelming amount of information about a patient that we have to go through in one session,” said Dr. Brian Patterson, lead author and associate professor of emergency medicine at UW Heath.
The study began in 2006, when UW Health began using digital health records, and is expected to run through 2023. At the start of the study, the average patient had about five notes in their record; by the end of the study, the average patient had about 359 notes.
The researchers, including Frank Liao, senior director of digital health and emerging technologies and co-author of the study, used a program to go through the charts and determine their size.
The program recorded several factors, including the total number of words, notes and tokens, which are groups of characters used by the artificial intelligence to represent text.
There is no solution yet to sift through all the data and make the charts more user-friendly, but the study points to the possibility of using AI to bring important information to the forefront.
The study does not mention whether this is also a problem in other large health systems, but it does point out that there is a need for better overall organization of medical records.
The results of the study were published in the Journal of the American Medical Informatics Association.
Daniel Hekman, Dr. Azita Hamedani, Dr. Manish Shah and Dr. Majid Afshar also contributed to the study.
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