Christopher V Almario1, William Chey2, Aung Kaung3, Cynthia Whitman4, Garth Fuller4, Mark Reid5, Ken Nguyen6, Roger Bolus7, Buddy Dennis8, Rey Encarnacion8, Bibiana Martinez9, Jennifer Talley9, Rushaba Modi10, Nikhil Agarwal10, Aaron Lee6, Scott Kubomoto6, Gobind Sharma6, Sally Bolus7, Lin Chang11, Brennan M R Spiegel9. 1. 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Division of Digestive Diseases, UCLA, Los Angeles, California, USA [4] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA. 2. Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. 3. 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. 4. 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA. 5. 1] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA. 6. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 7. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA. 8. UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, California, USA. 9. 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA. 10. 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Division of Digestive Diseases, UCLA, Los Angeles, California, USA. 11. Division of Digestive Diseases, UCLA, Los Angeles, California, USA.
Abstract
OBJECTIVES: Healthcare delivery now mandates shorter visits with higher documentation requirements, undermining the patient-provider interaction. To improve clinic visit efficiency, we developed a patient-provider portal that systematically collects patient symptoms using a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS also automatically "translates" the patient report into a full narrative history of present illness (HPI). We aimed to compare the quality of computer-generated vs. physician-documented HPIs. METHODS: We performed a cross-sectional study with a paired sample design among individuals visiting outpatient adult gastrointestinal (GI) clinics for evaluation of active GI symptoms. Participants first underwent usual care and then subsequently completed AEGIS. Each individual thereby had both a physician-documented and a computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (i) overall impression, (ii) thoroughness, (iii) usefulness, (iv) organization, (v) succinctness, and (vi) comprehensibility. We compared HPI scores within patient using a repeated measures model. RESULTS: Seventy-five patients had both computer-generated and physician-documented HPIs. The mean overall impression score for computer-generated HPIs was higher than physician HPIs (3.68 vs. 2.80; P<0.001), even after adjusting for physician and visit type, location, mode of transcription, and demographics. Computer-generated HPIs were also judged more complete (3.70 vs. 2.73; P<0.001), more useful (3.82 vs. 3.04; P<0.001), better organized (3.66 vs. 2.80; P<0.001), more succinct (3.55 vs. 3.17; P<0.001), and more comprehensible (3.66 vs. 2.97; P<0.001). CONCLUSIONS: Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete, and useful compared with HPIs written by physicians during usual care in GI clinics.
OBJECTIVES: Healthcare delivery now mandates shorter visits with higher documentation requirements, undermining the patient-provider interaction. To improve clinic visit efficiency, we developed a patient-provider portal that systematically collects patient symptoms using a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS also automatically "translates" the patient report into a full narrative history of present illness (HPI). We aimed to compare the quality of computer-generated vs. physician-documented HPIs. METHODS: We performed a cross-sectional study with a paired sample design among individuals visiting outpatient adult gastrointestinal (GI) clinics for evaluation of active GI symptoms. Participants first underwent usual care and then subsequently completed AEGIS. Each individual thereby had both a physician-documented and a computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (i) overall impression, (ii) thoroughness, (iii) usefulness, (iv) organization, (v) succinctness, and (vi) comprehensibility. We compared HPI scores within patient using a repeated measures model. RESULTS: Seventy-five patients had both computer-generated and physician-documented HPIs. The mean overall impression score for computer-generated HPIs was higher than physician HPIs (3.68 vs. 2.80; P<0.001), even after adjusting for physician and visit type, location, mode of transcription, and demographics. Computer-generated HPIs were also judged more complete (3.70 vs. 2.73; P<0.001), more useful (3.82 vs. 3.04; P<0.001), better organized (3.66 vs. 2.80; P<0.001), more succinct (3.55 vs. 3.17; P<0.001), and more comprehensible (3.66 vs. 2.97; P<0.001). CONCLUSIONS: Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete, and useful compared with HPIs written by physicians during usual care in GI clinics.
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