title: Computer-generated vs. physician-documented history of present illness (HPI): results of a blinded comparison.
abstract: OBJECTIVE
  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 a computer-generated HPI. Forty-eight blinded physicians assessed HPI quality across six domains using 5-point scales: (i) overall impression, (ii) thoroughness, (iii) usefulness, (iv) organization, (v) succinctness, and (vi) 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 than physician HPIs (3.68 vs. 2.80; P<0.001), 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<0.001), more useful (3.82 vs. 3.04; P<0.001), better organized (3.66 vs. 2.80; P<0.001), more succinct (3.55 vs. 3.17; P<0.001), and more comprehensible (3.66 vs. 2.97; P<0.001).
  
  
  CONCLUSIONS
  Computer-generated HPIs were of higher overall quality, better organized, and more succinct, comprehensible, complete, and useful compared with HPIs written by physicians during usual care in GI clinics.
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Division of Digestive Diseases, UCLA, Los Angeles, California, USA [4] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Almario
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: William
authors.initials: W
authors.lastname: Chey
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Aung
authors.initials: A
authors.lastname: Kaung
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Whitman
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Garth
authors.initials: G
authors.lastname: Fuller
authors.affiliation: 1] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Reid
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Nguyen
authors.affiliation: Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Bolus
authors.affiliation: UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, California, USA.
authors.forename: Buddy
authors.initials: B
authors.lastname: Dennis
authors.affiliation: UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, California, USA.
authors.forename: Rey
authors.initials: R
authors.lastname: Encarnacion
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Martinez
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Talley
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Division of Digestive Diseases, UCLA, Los Angeles, California, USA.
authors.forename: Rushaba
authors.initials: R
authors.lastname: Modi
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Division of Digestive Diseases, UCLA, Los Angeles, California, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kubomoto
authors.affiliation: Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Gobind
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Bolus
authors.affiliation: Division of Digestive Diseases, UCLA, Los Angeles, California, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Chang
authors.affiliation: 1] Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA [2] Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [3] Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D010808:Physical Examination; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D063189:Symptom Assessment