The relationship between structural characteristics of 2010 challenge documents and ratings of document quality

Quality of clinical narratives has direct impact on the perceived usefulness of these documents. With the advent of electronic documentation, the quality of clinical documents has been debated. Electronic documentation is supported by features to enhance efficiency, including copy/paste, templates, multi-level headings, and inserted objects. The impact of these features on perceived document quality has been difficult to assess in real settings as compared to simulations. This study used electronic notes from the 2010 i2b2/VA Challenge to explore the impact of text characteristics on general perception of document quality. We administered a validated instrument to assess document quality, focusing on two dimensions, informativeness and readability. Text characteristics were collected from both subjective ratings and quantitative summary. The results suggested common clinical elements such as templates, headings and inserted objects had strong positive association with document quality. Understanding of such relationship may prove useful in future EHR design and informatics research.