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.