Article Figures & Data
Figures
- Figure 1.
Diagram of content for 4 model notes. APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan.
- Figure 2.
Collapsible section header with counts (abnormal values, total organ systems) and abnormal text.
- Figure 3.
Section header expanded to reveal content detail with abnormal values visually emphasized.
Tables
- Table 1.
Description of Features for Four Model Electronic Health Record Note Visual Displays
Letter Name of Note Visual Display Model Features Distinguishing This Note Model A SOAP note Usual electronic health record format, serves as control B APSO two-column note Moves Assessment & Plan to top, adds second column for static data from the Past Family, Medical, and Social History C Collapsible APSO one column Same features as B, but only one column of text. Adds: Interactive, collapsible accordion display; headers for Review of Systems, Physical Exam, & Results displaying the abnormal text and showing abnormal item count & total organ system count; visual emphasis (bold & color type) for abnormal values in the body text of Review of Sytems, Physical Exam, & Results. D Collapsible APSO two column Same as C, but two columns instead of one APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan.
- Table 3.
Comparing Task Completion Time Differences (P < .05) among Different Electronic Health Record Note Models for Each Note Section
Task Note Model Versus Note Model P Physical exam A C .0125 A D <.0001 B C .0023 B D .0051 Results A C .0012 A D .0412 B C .0476 Review of systems A C .0255 A D .0048 B C .0065 B D .0065 Note models: A (traditional SOAP), B (two-column APSO), C (collapsible APSO), D (two-column collapsible APSO).
Only significant differences (P < .05) are displayed in the table.
APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan.
- Table 4.
Percent of Items Accurately Retrieved from All Possible Information for Each Electronic Health Record Note Type
Note Model Note Sections Included Mean (SD) Median (min-max) A (traditional SOAP) All 68.8 (11.9) 64.7 (52.9 to 88.2) Excluding Physical Exam 69.6 (11.8) 64.3 (57.1 to 62.9) B (2-column APSO) All 79.2 (14.6) 83.3 (46.7 to 93.3) Excluding Physical Exam 78.9 (13.9) 84.6 (46.2 to 92.3) C (collapsible APSO) All 80.5 (20.8) 90.6 (37.5 to 100.0) Excluding Physical Exam 79.5 (21.0) 89.3 (42.9 to 100.0) D (2-column collapsible APSO) All 69.1 (19.2) 75.0 (25.0 to 93.8) Excluding Physical Exam 75.5 (21.4) 75.0 (25.0 to 100.0) Note D contained a content error in the Physical Exam section that caused note D to perform disproportionately worse, thus we recalculated the results after removing the Physical Exam section from each of the four note models.
APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan; SD, standard deviation.
- Table 5.
Pairwise Comparisons of Accurate Retrieval of All Information for Each Electronic Health Record Note Type
Note vs. Note t Value Odds Ratio (95% CI) B C −0.16 0.96 (0.59 to 1.56) B D 0.81 1.22 (0.75 to 1.99) B A 2.22 1.66 (1.05 to 2.63) C D 0.98 1.27 (0.78 to 2.05) C A 2.43 1.73 (1.10 to 2.72) D A 1.37 1.37 (0.87 to 2.15) Note models: A (traditional SOAP), B (two-column APSO), C (collapsible APSO), D (two-column collapsible APSO).
Scores for each note pair were calculated without the faulty Physical Exam component.
APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan.
- Table 6.
Comparison (Paired t-test) of Note Types for Perceived Workload (NASA-TLX) and Usability (SUS)
Note Note Paired t-Test Results A B C D A Versus B A Versus C A Versus D Mean SD Mean SD Mean SD Mean SD P-Value P-Value P-Value TLX—Mental 3.25 (1.69) 3.00 (1.32) 2.50 (1.83) 2.56 (1.36) .52 .21 .21 TLX—Physical 1.75 (1.13) 1.56 (0.81) 1.44 (0.73) 1.38 (0.72) .38 .33 .23 TLX—Timing 4.25 (1.57) 4.31 (1.49) 3.25 (1.95) 3.50 (1.71) .85 .12 .18 TLX—Performance 3.81 (1.47) 3.63 (1.45) 2.69 (1.70) 3.31 (1.54) .66 .048 .43 TLX—Effort 3.94 (1.77) 3.50 (1.32) 2.88 (2.00) 2.69 (1.74) .30 .13 .043 TLX—Frustration 3.31 (1.78) 2.69 (1.54) 2.75 (1.98) 2.63 (1.75) .01 .41 .28 TLX—Overall 3.39 (1.21) 3.11 (0.86) 2.58 (1.51) 2.68 (1.14) .24 .11 .10 SUS* 58.50 (22.22) 74.83 (15.10) 81.83 (21.9) 77.50 (26.86) .007 .005 .009 ↵* There was one subject who had missing data for note A. This subject was excluded from analysis specific to SUS. Bold reflects significant mean differences where P < .05.
Note models: A (traditional SOAP), B (two-column APSO), C (collapsible APSO), D (two-column collapsible APSO).
NASA-TLX contains 6 subscale items and an overall mean subscale score, each on a 7-point Likert scale in which lower TLX scores indicate less workload.
System Usability Scale (SUS) is reported as a raw score (scale of 0 to 100) in which larger values are considered better usability.
TLX, Task Load Index; APSO, assessment, plan, subjective, objective; SOAP, subjective, objective, assessment, plan.
