JMIR Publications

ABSTRACT

Background:

Interventions to define medical jargon have been shown to improve Electronic Health Record (EHR) note comprehension among crowdsourced participants on Amazon Mechanical Turk (AMT). However, AMT participants may not be representative of the general population nor patients who are most at-risk for low health literacy.

Objective:

In this work we assess the efficacy of an intervention (NoteAid) on EHR note comprehension for participants in a community hospital setting.

Methods:

Participants were recruited from Lowell General Hospital (LGH), a community hospital in Massachusetts, to take the ComprehENotes test, a web-based test of EHR note comprehension. Participants were randomly assigned to control (85) or intervention (89) groups to take the test without or with NoteAid, respectively. For comparison, we used a sample of 200 participants recruited from AMT to take the ComprehENotes test (100 control and 100 intervention).

Results:

174 participants were recruited from LGH, 200 participants were recruited from AMT. Participants in both intervention groups (community hospital and AMT) scored significantly higher than participants in the control groups (P < 0.001). The average score for the community hospital participants was significantly lower than the average score for the AMT participants (P < 0.001), consistent with the lower education levels in the community hospital sample. Education level had a significant effect on scores for the community hospital participants (P < 0.0005).

Conclusions:

Use of NoteAid was associated with significantly improved EHR note comprehension in both community hospital and AMT samples. Our results demonstrate the generalizability of ComprehENotes as a test of EHR note comprehension and the effectiveness of NoteAid for improving EHR note comprehension.