Why EHRs Are Causing “Note Bloat”—And How We Can Fix It
What is “Note Bloat”?
“Note bloat” is a term familiar to most clinicians and medical professionals. It describes the cluttered, overwhelming notes that are stuffed with redundant or irrelevant data, making it hard to find what’s truly important. The irony? Much of this bloat is driven by the very structure of EHRs—systems that were supposed to streamline information, not create chaos.
How EHR Structure Encourages Note Bloat
Most EHRs are organized by data type—labs, images, medications, notes—each with its own designated section, often sorted by date or status. While this might seem logical on the surface, it doesn’t reflect how clinicians think or what they need for effective patient care.
Clinicians often need to understand the full picture around a clinical problem, rather than just seeing a list of lab results or medications. But because EHRs don’t organize data by problem or context, clinicians are forced to dump everything into a single note, making sure nothing gets lost in the disjointed EHR structure. This process has some unintended consequences:
• Objective data duplication: Clinicians often copy lab results, vitals, or imaging findings into notes—even though they’re available elsewhere in the EHR—just to make sure all relevant data is readily accessible in one place.
• Lack of critical thinking: This practice of “data dumping” conditions clinicians to focus on including everything, rather than thinking critically about what data is actually relevant to the patient’s current problem or the note’s purpose.
• Redundant information: By copying the same information into multiple notes, clinicians create cluttered, redundant notes that obscure the information that truly matters.
Why Do We Keep Copying Data?
The reason clinicians continue copying data into notes comes down to a few key issues:
• Convenience for Reviewers: When a note is reviewed, it helps to have all the data that informed clinical decisions readily available. This means copying lab results, imaging, and other objective data directly into the note, making it easier for others to understand the context of decisions.
• EHR Structure Constraints: Because EHRs don’t organize data by problem or context, clinicians have learned that the best way to “keep everything together” is to paste it into a note. So instead of having a clear problem-oriented view, we end up with bloated notes that lack structure or coherence.
A Missed Opportunity for Data Organization
The information needed to avoid note bloat is already there: objective data in EHRs is already structured and tagged with information like patient ID, problem, ordering physician, and date. However, because EHRs are organized by type and date, rather than by clinically relevant structures like “moment in time” or “medical problem,” clinicians are forced to do manual workarounds to make information accessible.
Imagine if EHRs organized data by temporal state, clinical problem, or even clinician perspective. This would mean:
• Clinicians wouldn’t need to copy every lab result or imaging finding into a note, because each piece of information would be accessible when and where it’s needed.
• Notes could be streamlined to focus on the most relevant insights and decisions, instead of serving as a dumping ground for any data that could be useful later.
• Clinicians could spend more time analyzing patient data, rather than formatting and re-entering it.
Our Solution: Problem-Oriented, Clinically Relevant Documentation
At River Records, we’re building a platform that lets clinicians document in a way that makes sense for clinical care—not for outdated filing structures. Our problem-oriented system organizes data by medical problem, helping clinicians capture the full context without creating bloated notes. Instead of redundant copying and pasting, we offer a streamlined way to view and document only what’s clinically necessary.
The Future of Clinical Documentation
EHRs shouldn’t require clinicians to do workaround after workaround just to get a clear picture of a patient’s health. Instead, we need systems that reflect the true complexity of clinical care, organizing data in a way that’s problem-focused, contextually relevant, and useful in real time.
Let’s move beyond “note bloat” and embrace documentation that enhances, rather than obstructs, patient care.
