Computer-Generated Vs. Physician-Documented History of Present Illness (HPI): Results of a Blinded Comparison

Abstract

Background Healthcare delivery now mandates shorter visits with higher documentation requirements, undermining the patient-provider interaction. To improve clinic visit efficiency, we developed a patient-provider portal that systematically collects patient symptoms using a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS also automatically “translates” the patient report into a full narrative history of present illness (HPI). We aimed to compare the quality of computer-generated vs. physician-documented HPIs. Methods We performed a cross-sectional study with a paired sample design among individuals visiting outpatient adult gastrointestinal (GI) clinics for evaluation of active GI symptoms. Participants first underwent usual care and then subsequently completed AEGIS. Each individual thereby had both a physician-documented and computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (1) overall impression; (2) thoroughness; (3) usefulness; (4) organization; (5) succinctness; and (6) comprehensibility. We compared HPI scores within patient using a repeated measures model. Results Seventy-five patients had both computer-generated and physician-documented HPIs. The mean overall impression score for computer-generated HPIs was higher versus physician HPIs (3.68 vs. 2.80; p<.001), even after adjusting for physician and visit type, location, mode of transcription, and demographics. Computer-generated HPIs were also judged more complete (3.70 vs. 2.73; p<.001), more useful (3.82 vs. 3.04; p<.001), better organized (3.66 vs. 2.80; p<.001), more succinct (3.55 vs. 3.17; p<.001), and more comprehensible (3.66 vs. 2.97; p<.001). Conclusion Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete and useful compared to HPIs written by physicians during usual care in GI clinics.

Computer versus physician identification of gastrointestinal alarm features

“…Similar to our previous report comparing physician-documented versus patient self-reported chief complaint, [9] we discovered a frequent mismatch between physician HPI-documented and patient self-reported alarm features. From the patient perspective, it is possible that some patients did not report alarm features to their physician or felt more comfortable reporting it to the computer.…”

“…We describe the AEGIS algorithm in detail elsewhere [9]. Briefly, we created AEGIS with the goal of improving the patient-physician relationship.…”

“…Based on this, we designed the AEGIS algorithm to systematically collect information from the patient prior to the visit, allowing them to tell their own “story” about their GI symptoms without time or locale restraints. AEGIS takes this information and creates a symptom report that includes a GI symptom “heat map” [9] and GI HPI (detailed below) that physicians can review prior to or concurrent with seeing the patient; this leaves more time during the visit for counseling and education which we hypothesize positively impacts patient–physician communication. Moreover, AEGIS supports both the patient and physician by creating a tailored educational prescription informed by the information previously collected by the algorithm.…”

“…Our group, in an effort to improve the quality and comprehensiveness of gastrointestinal (GI) notes in EHR-integrated practices, developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that is available through a patient-provider portal [9]. AEGIS systematically collects both GI symptom and alarm feature information from patients through its history of present illness (HPI) and alarm feature modules, respectively.…”

“…AEGIS systematically collects both GI symptom and alarm feature information from patients through its history of present illness (HPI) and alarm feature modules, respectively. We previously compared the quality of reports generated by the AEGIS HPI module to those written by physicians during usual care in academic GI clinics [9]. Here, blinded raters deemed the computer-generated HPIs to be more complete, succinct and useful compared to physician-documented HPIs.…”