Assessment of Electronic Health Record Search Patterns and Practices by Practitioners in a Large Integrated Health Care System.

Importance The electronic health record (EHR) is a source of practitioner dissatisfaction in part because of challenges with information retrieval. To improve data accessibility, a better understanding of practitioners' information needs within individual patient records is needed. Objective To assess EHR users' searches using data from a large integrated health care system. Design, Setting, and Participants This retrospective cross-sectional analysis used EHR search data from Kaiser Permanente Northern California, an integrated health care delivery system with more than 4.4 million members. Users' EHR search activity data were obtained from April 1, 2018, to May 15, 2019. Main Outcomes and Measures Search term frequency was grouped by user and practitioner types. Network analyses were performed of co-occurring search terms within a single search episode, and centrality measures for search terms (degree and betweenness centrality) were calculated. Results A total of 12 & x202f;313 & x202f;047 search activities (including 4 & x202f;328 & x202f;330 searches and 7 & x202f;984 & x202f;717 result views) conducted by 34 & x202f;735 unique users within 977 & x202f;160 unique patient EHRs were identified. In aggregate, users searched for 208 & x202f;374 unique search terms and conducted a median of 4 searches (interquartile range, 1-28 searches). Of all 97 & x202f;367 active EHR users, 34 & x202f;735 (35.7%) conducted at least 1 search. However, of all 12 & x202f;968 active EHR physician users, 9801 (75.6%) conducted at least 1 search, and of all 1908 active pharmacist users, 1402 (73.5%) conducted at least 1 search. The top 3 most commonly searched terms were statin (75 & x202f;017 searches [1.7%]), colonoscopy (73 & x202f;545 [1.7%]), and pft (54 & x202f;990 [1.3%]). However, wide variation in top searches were noted across practitioner groups. Terms searched most often with another term in a single linked search episode included statin, lisinopril, colonoscopy, gabapentin, and aspirin. Conclusions and Relevance Although physicians and pharmacists were the most active users of EHR searches, search volume and frequently searched terms varied considerably by and within user role. Further customization of the EHR interface may help leverage users' search content and patterns to improve targeted information retrieval. This cross-sectional study uses data from a large integrated health care system to assess search patterns and practices among electronic health record users. Question What are the electronic health record search patterns and practices among electronic health record users? Findings In this cross-sectional study of 12 & x202f;313 & x202f;047 patient electronic health record search activities, physicians and pharmacists conducted the most searches, with statin, colonoscopy, and pft being the most frequently searched terms. Search term networks revealed how users bridged together data across various domains relevant to a single clinical interaction. Meaning Our results suggest that opportunities exist for improving the clinical use of the electronic health record by identifying potential areas to customize information retrieval based on diverse user roles and linked search approaches.