Researchers develop test to evaluate patient health literacy

Researchers have developed a tool capable of evaluating patients' electronic health records (EHR) note comprehension to provide insight into where improvements can be made. Findings were published April 24 in the Journal of Medical Internet Research.

Patient portals allow patients to view EHRs and clinical notes, but individuals with lower health literacy could be missing information if they struggle to understand their notes. In this study, researchers outlined the development of ComprehENotes, a tool for assessing EHR comprehension.


“Providing patients direct access to their EHR clinical notes can enhance patients’ understanding of their clinical conditions and improve their health care outcomes,” wrote first author John Lalor, MS, and colleagues. “However, patients with limited health literacy may struggle to understand the content of their medical notes, which can include visit summaries with medical terms, lab reports and terms and phrases that are not common outside of medicine. A patient’s health literacy can have an impact on their desire to engage with their own personal health record.”

To build the tool, researchers used representative EHR notes for each six common diseases to generate questions. The questions were analyzed using item response theory (IRT) to identify questions to test EHR note comprehension. A total of 154 questions were developed from 29 EHR notes.

Researchers identified 83 questions for inclusion in the Amazon Mechanical Turk crowdsourcing tasks—53 of which were analyzed by IRT. The fully developed tool included 55 questions, with an additional 14 items capable of evaluating patients’ health literacy.

“We developed ComprehENotes, an instrument for assessing EHR note comprehension from existing EHR notes, gathered responses using crowdsourcing, and used IRT to analyze those responses, thus resulting in a set of questions to measure EHR note comprehension,” concluded Lalor and colleagues. “ComprehENotes was developed by generating questions directly from real patient de-identified EHR notes. Key concepts from the notes were identified by physicians and medical researchers as part of the question generation process. These concepts were deemed important for patients to understand, and the test questions were designed to assess comprehension of these concepts.”