Background: Many modern electronic medical record (EMR) systems permit application of templates to hospital After Visit Summaries (AVS). A need remains for enhancement of the document’s completeness and readability to enable successful patient self-management. Such advancements must balance with provider usability of EMR tools. This study evaluates the impact of a novel EMR tool, disappearing help text (DHT), on AVS quality and provider efficiency and satisfaction with its use.
Methods: Internal medicine residents (N=15) at an academic medical center created two AVSs for a mock chronic obstructive pulmonary disease (COPD) hospitalization: one with free-text format and another using DHT. Provider satisfaction, document preparation time, word count, readability, and critical elements were assessed for both versions.
Results: Average DHT AVS preparation time was 8.7 minutes versus 11.4 minutes for the free-text AVS (p=0.004). DHT use improved Flesch-Kincaid Reading Level from 7.3 to 5.9 (p=0.003) and Flesch Reading Ease score from 66 to 71.2 (p=0.01). DHT AVS were on average 425 words (95% CI) shorter than free-text AVS, though not statistically significant (p=0.096). DHT AVS included more critical elements: provider name (p< 0.001) and contact information (p< 0.001), smoking cessation referral (p=0.046), pulmonary rehabilitation instructions (p=0.005), and COPD action plan reference (p< 0.001). Surveys showed providers preferred DHT for ease of use and critical elements guidance.
Conclusions: The disappearing help text template improved After Visit Summary quality, readability, and length, and was associated with improved provider efficiency, usability, and satisfaction. Application of novel electronic medical record tools like disappearing help text can improve patient-facing documents without adding undue burden to provider workflow.