Accepted for/Published in: JMIR Formative Research
Date Submitted: Aug 17, 2020
Date Accepted: Apr 11, 2021
Impact of an Online Gastrointestinal Symptom History Taker on Physician Documentation and Charting Time: Results from a Pragmatic Controlled Trial
ABSTRACT
Background:
A potential benefit of electronic health records (EHRs) is that they might save clinician time and improve documentation by auto-generating the history of present illness (HPI) in partnership with patients prior to the clinic visit. We developed an online patient portal called AEGIS (Automated Evaluation of Gastrointestinal [GI] Symptoms) that systematically collects patient GI symptom information and then transforms the data into a narrative HPI which is available for physicians to review in the EHR prior to seeing the patient.
Objective:
To compare whether use of an online GI symptom history taker called AEGIS improves provider-centric outcomes vs. usual care.
Methods:
We performed an interrupted time series study among adults ≥18 yo scheduled for a new patient visit at 4 GI clinics at an academic medical center. Patients who completed AEGIS were matched with controls who underwent usual care in the pre-intervention period as well as those in the intervention period who did not complete AEGIS. We then compared the following outcomes among groups: (i) documentation of alarm symptoms; (ii) documentation of family history of GI malignancy; (iii) number of follow-up visits in a 6-month period; (iv) number of tests ordered in a 6-month period; and (v) charting time (difference between appointment time and time encounter was closed). Multivariable regression models were used to adjust for potential confounding.
Results:
Of the 774 patients who were invited to complete AEGIS, 116 (15.0%) finished it prior to their visit. The 116 AEGIS patients were then matched with 343 and 102 controls in the pre- and post-intervention periods, respectively. There were no statistically significant differences among the groups for documentation of alarm symptoms and GI cancer family history, number of follow-up visits and ordered tests, or documentation time.
Conclusions:
Use of a validated online HPI-generation portal did not improve physician documentation or reduce workload. Given universal adoption of EHRs, further research examining how to optimally leverage patient portals for improving outcomes are needed.
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