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Hall NJ, Berry SK, Aguilar J, Brier E, Shah P, Cheng D, Herman J, Stein T, Spiegel BMR, Almario CV. Impact of an Online Gastrointestinal Symptom History Taker on Physician Documentation and Charting Time: Pragmatic Controlled Trial. JMIR Form Res 2021; 5:e23599. [PMID: 33944789 PMCID: PMC8132977 DOI: 10.2196/23599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/18/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background A potential benefit of electronic health records (EHRs) is that they could potentially 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 that is available for physicians to review in the EHR prior to seeing the patient. Objective This study aimed to compare whether use of an online GI symptom history taker called AEGIS improves physician-centric outcomes vs usual care. Methods We conducted a pragmatic controlled trial among adults aged ≥18 years scheduled for a new patient visit at 4 GI clinics at an academic medical center. Patients who completed AEGIS were matched with controls in the intervention period who did not complete AEGIS as well as controls who underwent usual care in the pre-intervention period. Of note, the pre-intervention control group was formed as it was not subject to contamination bias, unlike for post-intervention controls. We then compared the following outcomes among groups: (1) documentation of alarm symptoms, (2) documentation of family history of GI malignancy, (3) number of follow-up visits in a 6-month period, (4) number of tests ordered in a 6-month period, and (5) charting time (difference between appointment time and time the 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 charting time (all P>.05). 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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Affiliation(s)
- Natalie J Hall
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sameer K Berry
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jack Aguilar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Elizabeth Brier
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Parth Shah
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Derek Cheng
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jeremy Herman
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Theodore Stein
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States
| | - Christopher V Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States
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