The first version of Diagnose note review screen showed everything at once. Every section of the note was expanded by default. Edit history was visible in the margin. A push to EHR button sat at the top alongside a review status indicator and a timestamp. We had designed it for completeness and physicians found it exhausting to look at.
This is a common mistake in clinical software. The assumption that more information on screen means more confidence. In practice it means more cognitive load on people who have already spent the last 20 minutes managing a complex human situation.
What we observed
We watched physicians use the old screen during site visits at three clinics. The pattern was consistent. They would land on the note open it fully scroll to the bottom then scroll back to the top and start reading from the beginning. They were reorienting themselves every time. The screen was not giving them a clear place to start.
We also noticed that most physicians only ever edited one or two sections per note. The Assessment and Plan. Everything else — HPI vital signs review of systems — they read and moved on. But the screen treated every section as equally urgent.
What we changed
The new screen collapses all sections by default except Assessment and Plan which open automatically. A quiet left border indicator signals sections that may need attention without using colour or iconography that reads as alarming. Edit history moved behind a toggle — available when needed invisible when not.
The push to EHR button moved to the bottom of the screen. This sounds like a small change. It means physicians read the note before they sign it rather than seeing the action before the content.
Time to sign off dropped. Physician feedback improved. We should have done it earlier.
