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

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.