Abstract
BackgroundA 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.ObjectiveThis study aimed to compare whether use of an online GI symptom history taker called AEGIS improves physician-centric outcomes vs usual care.MethodsWe 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.ResultsOf 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).ConclusionsUse 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.
Highlights
To facilitate communication between patients and physicians in electronic health record (EHR)–integrated environments, we developed an online patient portal (MyGiHealth) that uses a computer algorithm called Automated Evaluation of Gastrointestinal (GI) Symptoms (AEGIS) to systematically collect patients’ symptom information before the clinic visit
While our prior studies noted that AEGIS creates higher quality history of present illness (HPI) and collects more alarm features vs physicians [1,2], we found that it did not improve patient satisfaction or shared decision making when compared to usual care in a controlled trial [3]
For patients who completed AEGIS, their physicians were notified 1 day before the visit that their HPIs were uploaded to the notes section of our EHR (Epic, Verona, WI) for review
Summary
To facilitate communication between patients and physicians in electronic health record (EHR)–integrated environments, we developed an online patient portal (MyGiHealth) that uses a computer algorithm called Automated Evaluation of Gastrointestinal (GI) Symptoms (AEGIS) to systematically collect patients’ symptom information before the clinic visit. The data are transformed into a full narrative history of present illness (HPI) that clinicians can review prior to meeting the patient. 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 transforms the data into a narrative HPI that is available for physicians to review in the EHR prior to seeing the patient
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