"Note bloat" is a health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. As part of our documentation quality improvement initiative, we promote practical ways for clinicians to promote succinct, clear and actionable charting.
The clinical value of progress (non-summative) documentation relates to a ratio of signal (clinically important new information reflecting developments in a patient's experience) to noise (information related to the patient, but not directly related to clinical progress) multiplied by interpretation (application of clinical expertise to advance understanding and support decision-making):
Digital health records make it easy to amplify noise in progress documentation. Copy-paste and text automations ("SmartStuff") pull data blocks (e.g., lab result flowsheets) into a note. These can bring signal at the cost of excess noise. Authors can be lulled into thinking that documentation is done; but the note has little clinically helpful interpretation. The reader of a progress note needs to know what the writer thought and did for patient care.
