Health Care Provider Satisfaction With a New Electronic Progress Note Format: SOAP vs APSO Format

Many health care organizations are deploying electronic health records (EHRs).¹ A health care provider's EHR progress notes are essential for effective communication. However, these notes may increase errors when they are difficult to read.² Billing requirements, regulatory statements, and extensive inclusion of test results detract from progress note brevity and clarity.³ In our experience, EHR progress notes that include such elements can span 17 electronic pages, rendering actual clinical reasoning extraordinarily difficult to locate. Missing data can lead to lost productivity and increased cost.⁴ Health care providers' frustration with EHR progress notes may interfere with EHR adoption^5- 6 and deployment.⁷ Although the traditional SOAP (Subjective, Objective, Assessment, Plan) format⁸ mirrors the sequence of a clinical encounter, it translates poorly from paper medical charts to the EHR. Finding the Assessment and Plan requires considerable on-screen “scrolling.” We examined the adoption of an alternate APSO (Assessment, Plan, Subjective, Objective) format, which places the Assessment and Plan at the top of the note, where it is readily located when the EHR note is opened. We hypothesized it would improve readability and satisfaction and shorten the time to answer clinical questions.