• Brian W Pickering, Ognjen Gajic, Adil Ahmed, Vitaly Herasevich, and Mark T Keegan.
• Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
• Crit. Care Med.. 2013 Jun 1;41(6):1502-10.

ObjectivesInformation overload in electronic medical records can impede providers' ability to identify important clinical data and may contribute to medical error. An understanding of the information requirements of ICU providers will facilitate the development of information systems that prioritize the presentation of high-value data and reduce information overload. Our objective was to determine the clinical information needs of ICU physicians, compared to the data available within an electronic medical record.DesignProspective observational study and retrospective chart review.SettingThree ICUs (surgical, medical, and mixed) at an academic referral center.SubjectsNewly admitted ICU patients and physicians (residents, fellows, and attending staff).Measurements And Main ResultsThe clinical information used by physicians during the initial diagnosis and treatment of admitted patients was captured using a questionnaire. Clinical information concepts were ranked according to the frequency of reported use (primary outcome) and were compared to information availability in the electronic medical record (secondary outcome). Nine hundred twenty-five of 1,277 study questionnaires (408 patients) were completed. Fifty-one clinical information concepts were identified as being useful during ICU admission. A median (interquartile range) of 11 concepts (6-16) was used by physicians per patient admission encounter with four used greater than 50% of the time. Over 25% of the clinical data available in the electronic medical record was never used, and only 33% was used greater than 50% of the time by admitting physicians.ConclusionsPhysicians use a limited number of clinical information concepts at the time of patient admission to the ICU. The electronic medical record contains an abundance of unused data. Better electronic data management strategies are needed, including the priority display of frequently used clinical concepts within the electronic medical record, to improve the efficiency of ICU care.

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