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

Abstract

Introduction and Objectives The accuracy of conclusions based on Electronic Healthcare Record (EHR) research is highly dependent on the correct selection of descriptors (codes) by users. 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 of actors portraying 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 22 participants completed the study, reporting only minor difficulties. 132 screen prints 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 (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 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 oversight.