S1527 Electronic Smart Phrase Is Superior to an Online Calculator for Liver Fibrosis Index FIB-4

Abstract

Introduction: Clinical scores are becoming more frequently used in clinical encounters. While these scores can be calculated using the formula directly or via online calculators, electronic health records (EHR) may incorporate the calculations using Smart Phrases. Fibrosis-4 (FIB-4) index, incorporates age, serum aspartate aminotransferase level, serum alanine aminotransferase level, and platelet counts to determine the degree of hepatic fibrosis. The aim of this study is to compare the performance of online calculator for FIB-4 with EPIC Smart Phrase. Methods: FIB-4 score was established as a Smart Phrase in Epic and a trial was performed on internal medicine residents at a community teaching hospital during March-May 2022 on calculating this score via traditional online method using MDCalc medical calculator (https://www.mdcalc.com/fibrosis-4-fib-4-index-liver-fibrosis) vs EHR-based approach. Total number of clicks (steps) and time spent calculating FIB-4 score, and accuracy of calculation were measured via one single observer in both traditional and EHR-based approaches using a sample patient. Ease of calculation was reported for both methods by participants on a 0-10 scale. P < 0.05 was considered significant. Results: A total of 37 internal medicine residents participated in the study. Thirteen (35.1%) of the participants were in post-graduate year (PGY)-1, while individuals in PGY-2 and PGY-3 had 12 (32.4%) participants each. Thirteen (35.1%) of the participants were female. In comparison to the online calculator, participants used less clicks (steps; 11.3 ± 4.1 vs 1.9 ± 0.9, P < 0.001) and less time (60.1 ± 8.8 seconds vs 6.6 ± 3.4 seconds, P < 0.001) to calculate FIB-4 score via Epic Smart Phrase. Participants reported higher scores for ease of calculating the FIB-4 score using Epic Smart Phrase compared to the online calculator (5.6 ± 1.0 vs 8.1 ± 0.9, P < 0.001). Also, while 6 (16.2%) inaccurate calculations were observed using the online calculator, no inaccurate calculations were noted in calculating the score using the Epic Smart Phrase (P = 0.01). Conclusion: EPIC Smart Phrase for liver fibrosis index FIB-4 is easier and faster to use compared to online calculator.