Improving the Understandability and Actionability of Clinical Notes to Support Self-care in Patients with a Chronic Disease: A Pilot Study Applies Survey and Eye-Tracking Approach

The OpenNotes movement, advocating for healthcare transparency, has positively impacted over 50 million patients by sharing clinical notes. Although note sharing has many positive benefits, such as enhancing medication adherence and communication, patients, particularly with low health literacy, may not be able to understand the notes written by physicians due to medical jargon and complex terminology. To address this, we propose an informatics-based approach to help simplify clinic notes in order to help improve understandability and actionability. This paper outlines the pilot study conducted with clinical notes from diabetic patients in a academic teaching hospital. These de-identified notes were revised using a semi-automated pipeline. Nine pre-medical undergraduate students evaluated the understandability and actionability of the original and revised notes. The results showed significant improvements in both aspects. Eye-tracking data indicated increased focus on the revised notes, especially on sections explaining diabetic terms, despite their smaller size compared to the main text. This study suggests the potential for improvements in clinic notes for diabetic patients using informatics and form a solid basis for large scale research and development to help promote shared decision making with patients.