Filmed Monologue Vignettes: a novel method for investigating how clinicians document consultations in electronic health records

Abstract

Introduction and objectives: The accuracy of conclusions from research based on Electronic Healthcare Records (EHRs) is highly dependent on the correct selection of descriptors (codes) by users, but few methods exist for examining quality and drivers of documentation. We aimed to evaluate the feasibility and acceptability of filmed vignette monologues as a resource-light method of assessing and comparing how different EHR users record the same clinical scenario.

Methods: Six short monologues portraying simulated patients presenting allergic conditions to their General Practitioners were filmed head-on then electronically distributed for the study; no researcher was present during data collection. The method was assessed by participant uptake, reported ease of completion by participants, compliance with instructions, the receipt of interpretable data by researchers, and participant perceptions of vignette quality, realism and information content.

Results: Twenty-two participants completed the study, reporting only minor difficulties. 132 screenshots were returned electronically, enabling analysis of codes, free text and EHR features. Participants assigned a quality rating of 7.7/10 (range 2-10) to the vignettes and rated the extent to which vignettes reflected real-life at 93% (range 86-100%). Between 1 and 2 hours were required to complete the task. Full compliance with instructions varied between participants, but was largely successful.

Conclusions: Filmed monologues are a reproducible, standardized method, which require relatively few resources, yet allow clear assessment of clinicians' and EHRs systems' impact on documentation. The novel nature of this method necessitates clear instructions, so participants can fully complete the study without face-to-face researcher supervision.

Figure 1: Vignette stills including their clinical presentation

Figure 2: Study Procedure

Figure 3: Example screen prints from SystmOne (top) and Vision (bottom). 1 = Read code entry, 2 = Free text entry, 3 = Allergy entry feature, 4 = Combined Read code and free text, 5 = EHR features (patient and professional information resources)

Figure 3: Example screen prints from SystmOne (top) and Vision (bottom). 1 = Read code entry, 2 = Free text entry, 3 = Allergy entry feature, 4 = Combined Read code and free text, 5 = EHR features (patient and professional information resources)