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Updated: Sep 12, 2025

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Disappearing Text as a Clinical Decision Support Layer: A Case Series.

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Disappearing text (DT) clinical decision support (CDS) tools improved documentation for IV antibiotics and advanced care planning when combined with other CDS methods. DT alone did not significantly improve anticoagulation planning documentation.

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Area of Science:

  • Clinical Informatics
  • Health Information Technology
  • Medical Documentation

Background:

  • Clinical decision support (CDS) tools aim to improve healthcare quality and efficiency.
  • Inline disappearing text (DT) is a type of CDS that provides prompts within the electronic health record.
  • Evaluating the effectiveness of different DT configurations is crucial for optimizing its use.

Purpose of the Study:

  • To assess the impact of inline disappearing text (DT) clinical decision support (CDS) tools on clinician documentation.
  • To compare the effectiveness of DT alone versus DT combined with other CDS interventions (SmartList, OurPractice Advisory).
  • To evaluate documentation rates for perioperative anticoagulation, pre-discharge IV antibiotics, and advanced care planning.

Main Methods:

  • A case series design was employed to evaluate three scenarios of DT implementation.
  • Scenario 1: DT for perioperative anticoagulation planning.
  • Scenario 2: DT with SmartList for pre-discharge IV antibiotic planning.
  • Scenario 3: DT with SmartList and OurPractice Advisory for advanced care planning.
  • Documentation rates were compared pre- and post-intervention using Chi-square analyses.

Main Results:

  • No significant change in perioperative anticoagulation plan documentation (Scenario 1).
  • Significant increase in pre-discharge IV antibiotic planning documentation (60% to 93%, p < 0.001) when DT was paired with a SmartList (Scenario 2).
  • Significant increase in advanced care planning note documentation (43% to 52%, p < 0.001) when DT was combined with a SmartList and Advisory (Scenario 3).

Conclusions:

  • Combining disappearing text (DT) with other clinical decision support (CDS) tools significantly improved documentation for pre-discharge IV antibiotics and advanced care planning.
  • Disappearing text (DT) alone did not demonstrate a significant impact on perioperative anticoagulation planning documentation.
  • Sociotechnical factors likely influence the effectiveness of DT, suggesting a need to consider technology, people, workflow, and culture for optimal implementation.