Study shows how persuasive design principles in primary care could improve data entry in EHRs

Accurate patient data is critical for the health of the patient as well as for record keeping and reporting for the primary care practice. Entering patient data can be time consuming and may not always be done in a timely manner. Even though electronic health records (EHRs) enable the primary care physician to enter data and update visit notes during the patient visit while continuing to stay focused on the patient interaction, many providers do not complete their notes right away.

Same day notes have been shown to be more accurate, but studies have also shown that only about half of clinicians seeing patients actually input those notes on the same day as the visit. A recent research study set out to determine how to encourage more primary care physicians to complete their EHR data entry on the patient visit day. The study objective incorporated the need to “find ways to influence clinician’s behaviors around data entry and data quality.”

In addition to the timing of the entry, the study found a need for encouraging EHR users to “enter a complete entry within the structured form, and encouraging error-free entries.” The study objective was to “to expose clinicians to persuasive design in order to modify their data-entry behaviors.”

Through a process of analysis and context definitions, the researchers “identified several persuasive design principles that could help change the data-entry behavior.” Some of the persuasive design elements included visuals such as a summary screen and badges “to encourage and normalize entering data on the same day.” In particular, the design incorporated a “same day badge” that was “programmed to display and reward the percentage of same-day entries.”

The researchers tested the persuasive design of the EHR with 53 users over a period of 16 weeks, including 8 weeks prior to the change and 8 weeks after. At the end of the post-change period, the team conducted an analysis and found that “the intervention increased the percentage of same-day entries by 10.3%.” Recognizing the limitations of their study, including the number of test subjects and the research timeframe, the researchers indicated that “Future work will involve exploring and evaluating the long-term impacts in greater detail as well as assessing iterative improvements to the design.”